Honey crusted lesion on child face… Impetigo

CO of impetigo… staph aureus

DOC of impetigo… topical mupirocin/ Bactran

School exclusion… 1 day after abs TTT

TTT of bullous impetigo… Hydration+ IV abs

Pt with red, hot& swollen leg+ high grade fever………………….…. Cellulitis

MC CO………………. step pyogenes

TTT of choice……. IV flucloxacillin

Pt with red, hot& swollen leg+ high grade fever………………….…. Cellulitis

Pt with red, hot& swollen leg+ warfarin therapy…………………..… Hematoma

Pt with red, hot& swollen leg+ past H/O DVT or RF for DVT…….. DVT

CO of acne………… Propiinibacterium acne

Mild cases……...… benzoyl peroxide

Severe cases……. Oral isotritenon (contra-indicated in pregnancy)

While lesions of bad odor between toes in athletic pt… Tinea pedis

TTT…… antifungal cream/ powder (e.g. miconazole)

Red scaly lesion on inguinal region with severe itching… Tinea cruris

Hypo-pigmented macules on the back, neck, shoulders… Tinea versicolor

CO of tinea versiclor… malassezia furfur (mycelial form)

TTT…… topical selenium sulphide

Itchy lesion with pale center& red scaly boarder… Tinea corporis

TTT… Topical azoles

Whitish lesions in between the finger with bad odor…..tinea pedis

DOC of pediculosis… Permethrin

Scabies…… Intense itchy patch with linear burrows

Scabies…… Severe itching at night affecting all family members

CO… Female Sarcoptes scabiei

TTT… permethrin even in kids and pregnancy

Re treat the patient again after 1-2 weeks

Prolonged itching after scabies is normal and usually requires NO ttt or cortisone

Multiple vesicles on erythematous base on lips ………… HSV “herpes libialis”

Multiple painful vesicles on genitalia ………………………… HSV “herpes genitalis”

Multiple vesicles on erythematous base on fingers …… HSV “herpes whitlow”

Herpes libialis……………Vesicles on lips of child

Herpangina……………… Vesicles on palate, post pharynx of child

HSV encephalitis… fever, confusion, seizures (Affects mainly temporal lobe)

Inv of choice……. LP: ++ lymphocytes and ++ RBCs

TTT…………………. IV acyclovir

Pregnant with active genital HSV lesions… CS is a MUST

Pregnant with active breast HSV lesions… NO lactation

How to differentiate 1ry from recurrent herpes… Serology

Pain at face + redness……………………………….. varicella infection

Varicella + facial n palsy……………………………. Ramsay Haunt $

Pain at face only (H/O vesicular lesion)……. Post- herpetic neuralgia

TTT of varicella in 1st 72 hours………. Acyclovir

TTT of caricella >72 hs………………….. Only analgesic

TTT of post-herpetic neuralgia………1st line: Carbamazipine 2nd line: amitryptiline

CO of condyloma accuminata… HPV (check images for the lesion)

NO serology is recommended for Dx of condyloma accuminata

TTT of choice……… podophyllin resins.

Autosuggestion………spontaneous resolution of condyloma accuminata even with

out ttt

If podophyllin resins fails… cryotherapy, laser, electrocautry

TTT of choice in pregnancy………… Cryotherapy

If cryotherapy fails in pregnancy… leave it alone

Flesh colored, dome shaped papule with central umblification… molluscum

contagiosum

CO………………………………. Poxvirus

School exclusion………….. NOT recommended

Dry papular rash with itchy skin affecting mainly flexures… Atopic dermatitis

Association… other atopic disorders (asthma, allergic rhinitis)

Most common sites……….flexures and face

Papular itchy rash resulting from contact with an allergen… contact dermatitis

MCC of contact dermatitis… Nickel

TTT…………………………………. Cortisone cream

Generalized red patches after drug ingestion………. Urticaria

Generalized well- defined wheel+ hypotension+ wheezes, lip and tongue swelling…
Angioedema

TTT of urticaria………….. Oral anti-histaminic ( cetrizine )

TTT of angioedema…… IM adrenaline ( 1: 1000 )

Red rash after ingestion of ampicillin for URTI… IMN

MC drug causing angioedema…………… ACE-Is

Hereditary angioedema…………………… C1 estrase inhibitor deficiency

TTT of angioedema…IM adrenaline/ intubation if severe respiratory distress

Yellow scaly lesions, easily removed leaving bleeding spots… Psoriasis

TTT of psoriasis…………. High potency Cortisone

Pt lost in Ice Mountains came with black fingers… Dx: frost bite injury

1st step in management… Rapid rewarming in water at 40-42 c

Red scaly itchy patch with multiple rashes around it… Pityriasis rosea

Pityriasis rosea lesion is called… Herald patch (check image)

Dermatitis in napkin area of child affecting fissures with satellite lesion… candida

Dermatitis in napkin area of child NOT affecting fissures with NO satellite lesion…
Napkin dermatitis

Female under stress develops hair loss… Telogen effluvium (Alopecia)

TTT… Reassure

Hair loss+ exclamation hair mark… Alopecia areata

1st line of TTT… local cortisone

Hypopigmented lesions of skin…. Vitiligo

Assosciation of vitiligo… other auto-immune diseases

TTT… Skin colored material (camouflage)

TTT of lipoma……….. excision

Whitish lesion on tongue removed by scraping……………………………… Candida

TTT of Candida… nystatin mouth wash

Smoker pt with Whitish lesion on tongue not removed by scraping… Leukoplakia

TTT of leukoplakia… removal (risk of SCC of tongue)

Old smoker with white lesion on tongue+Ulcer..Cancer tongue (NOT leukoplakia)

Old smoker with bloody stained saliva… Cancer tongue

Old smoker with any complaint at tongue= tongue cancer until proven otherwise

1st MC RF of melanoma…………………. H/O atypical nevi

2nd MC RF of melanoma……………………………. FH

3rd MC RF of melanoma……………………………. Sun exposure

1st step in atypical nevi………………….. Wide excision (with 2-3 Cm safety margin)

Recurrent lesion after excision…….. Excision again

Pathology report indicate malignant cells at margins… re-excision with wider

safety margin

Melanoma with enlarged LN……… Excision of both

Melanoma with liver metastases… Excision of both

Most imp prognostic factor of melanoma…………….. Depth of lesion

Melanoma near eye…………………………………………..…. Refer

Most imp advice to decrease risk of melanoma…… avoid sun exposure

Most imp advice to high risky pt with nevi… skin exam+- photography

H/O melanoma, now brain CT shows a mass………..melanoma

Pt was in ice 2-3 Ws ago came 2day with black coloration at fingers… Next step:
Excision (NOT re-warming; it is NOT frost bite lesion)

Dark ulcer in pt face… Basal cell carcinoma (BCC) until proven otherwise

Next step… Shave biopsy (biopsy with 2-3 mm safety margin)

TTT of choice… Moh’s surgery

Pathology report after removal of BCC indicates malignant cells… Excision again

Carcinoma of lower lip…………………..….. SCC

Carcinoma of tongue………………….……….SCC

Carcinoma of esophagus…………………….SCC

Carcinoma of marjolin ulcer……………….SCC

Carcinoma of chronic osteomyelitis….. SCC

Nodule in hand or face after mosquito bite…………….. Dermatofibroma

Female with face flushing occur with emotion or hot drinks… Rosacea

Flaky, red, itchy with yellow scales… Seborrheic dermatitis

TTT … Anti-fungal for children. Check HIV if severe lesions in adults

Old pt with scaly lesion face stuck-on appearance… Seborrheic keratosis

TTT… removal for cosmotic reasons (NO risk of malignancy)

Old pt with dark or light, pink or red scaly lesion … Aktinic keratosis
TTT… removal (risk of malignancy)

Dome shaped, rapid growing lesion in old pt… Keratoacanthoma

TTT… removal (risk of malignancy)

Small vascular lesion in pregnant or child after trauma… Pyogenic granuloma

TTT… Surgery (check image of pyogenic granuloma)

Severe itchy, painful vesicles on top of healed atopic dermatitis… Eczema

herpeticum

TTT… Acyclovir