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Common skin diseases

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Common skin diseases by Siriraj

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Common skin diseases

  1. 1. Common skin diseases Study material of Department of Dermatology, Faculty of medicine siriraj hospital
  2. 2. Acne-Introduction • affects about 85% of teenagers • may persist into the 40s, especially in women • Acne lesions usually occur on the face, neck, back, chest, and shoulders.
  3. 3. • Acne is a disorder resulting from the action of hormones + sebaceous glands + hair follicles. • Acne is multifactorial • genetic predisposition • relating to the number, size and activity of sebaceous glands-Sebum production How Does Acne Develop?
  4. 4. • microcomedo is an accumulation of sebum beneath a bottleneck formed by sticky shed keratinocytes blocking the proximal portion of the follicle How Does Acne Develop?
  5. 5. The hair+sebum+ keratinocytes fill the narrow follicle  a plug The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. When the wall of the plugged follicle breaks down, it spills sebum, shed skin cells, and bacteria – leading to lesions or pimples.
  6. 6. Acne- Type of lesions • Papules – inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch • Pustules – papules topped by white or yellow pus-filled lesions that may be red at the base • Nodules – large, painful, solid lesions that are lodged deep within the skin • Cysts – deep, painful, pus-filled lesions that can cause scarring.
  7. 7. Comedone Inflam papules Acne scar
  8. 8. Acne at back
  9. 9. Factors That Can Make Acne Worse • Hormone levels • Oil from skin products or grease from the work environment • Hard scrubbing of the skin • Stress • เครื่องแต่งกายที่รัดแน่น หมวกกันน็อค • สิ่งแวดล้อม เช่นมลภาวะ ความชื้น • แกะ บีบ สิว
  10. 10. How Is Acne Treated? • Goals of treatment – to heal existing lesions – To stop new lesions – to prevent scarring – to minimize the psychological stress and embarrassment • Drug treatment is aimed at reducing – abnormal clumping of cells in the follicles – oil production – bacteria – inflammation
  11. 11. Acne treatments • Benzoyl peroxide – destroys P. acnes, and reduce oil production • Resorcinol – can break down blackheads and whiteheads • Salicylic acid –break down blackheads, whiteheads and cut down the shedding of cells lining the hair follicles • Sulfur –break down blackheads and whiteheads • Antibiotics –stop or slow the growth of bacteria and reduce inflammation • Vitamin A derivatives (retinoids) – unplug existing comedones, decrease the formation of comedones
  12. 12. Corn Callous Callus
  13. 13. Corn • are caused by pressure on the skin from the underlying bone. • This may be caused by the bones having shifted, excessive weight, friction or pressure. • The body to protect itself, allows the skin to thicken to protect the area. • In some cases it presses on the bone or nerves and causes pain.
  14. 14. Treatment • aimed at reducing symptoms such as pain and discomfort with walking • the etiology of the foot pressure irregularity is determined • use of orthotics and conservative footwear with extra toe space • paring • use of keratolytic agents, such as ureas, alpha-hydroxy acid, salicylic acid – self-adhesive pads – 10-17% salicylic acid compounds – A carbon dioxide laser can be used to pare deep lesions
  15. 15. Papulosquamous diseases
  16. 16. Papules ScalePlaque Papulosquamous Diseases
  17. 17. Papulosquamous Diseases • โรคที่พบบ่อยได้แก่ 1. Psoriasis 2. Pityriasis rosea 3. Lichen planus 4. Lichen nitidus 5. Lichen striatus 6. Exfoliative dermatitis
  18. 18. 1. Psoriasis
  19. 19. • Chronic relapsing disease • World wide distribution • Adult onset (22-55 yrs) • Equally common in males and females • Many clinical patterns – Plaque type (Psoriasis vulgaris) – most common – Guttate type – Pustular type – Erythrodermic type Psoriasis
  20. 20. Plaque type
  21. 21. Psoriasis vulgaris-scalp lesion - erythema and scaling - normal hair, no alopecia
  22. 22. Psoriasis vulgaris-nail lesion - pitting nail - onychodystrophy with subungual hyperkeratosis
  23. 23. • 5-8% joint involvement in all type of psoriasis • Peripheral joint involvement : symmetric and asymmetric • Axial joint involvement :spine and sacroiliac • Associated features :tenosynovitis Psoriasis arthritis
  24. 24. • Eruption of multiple, small (0.5-1.5 cm) lesions • Frequently occur in young adult • Preceded by “Trigger Factors” Such as: • Bacterial infection • Aggressive local therapy • Etc. Guttate Psoriasis
  25. 25. Guttate psoriasis
  26. 26. • Generalized type (severe) • Preceded by “Trigger Factors” »Non-pregnant: steroid withdrawal »Pregnancy • Localized type • Palms & soles • Tips of fingers and toes lead to nail loss and severe atrophy Pustular psoriasis
  27. 27. Reiter’s syndrome
  28. 28. • Skin and joint symptoms • Immunological response • Develops several weeks after the gut or urinary tract infections with certain microorganisms Reiter’s syndrome
  29. 29. • Young male • HLA-B27 • Skin and mucosal involvement • Mouth ulcer (aphthous-like) • Conjunctivitis • Circinated, sicca balanitis • Keratodermia blenorrhagica (resemble pustular psoriasis) • Onychodystrophy • Acute oligoarthritis (knee and ankle) Reiter’s syndrome
  30. 30. 2. Pityriasis Rosea
  31. 31. • Acute, self-limiting eruption • Adolescent (10-35 yrs) • Herald patch 1-2 weeks before generalized lesions • Duration of disease 10-12 weeks • Recurrent rate – 3% Pityriasis Rosea
  32. 32. Herald patch
  33. 33. •Christmas tree distribution at trunk •“T-shirt and shorts” area of involvement
  34. 34. •Pink oval, small plaque •Collarette scale
  35. 35. 3. Lichen planus
  36. 36. • “The four’s P”:purple, polygonal, pruritic, papule • Age 30-60 years • Mucosal lesion: lace-like at buccal mucosa • Nail involvement: 10-15% of cases Lichen Planus(LP)
  37. 37. Polygonal violaceous papules and plaques
  38. 38. Whitish lace-like erosive patch at buccal mucosa
  39. 39. 4. Lichen nitidus
  40. 40. • Asymptomatic • Koebner phenomenon, occasionally occur • Resolve spontaneously after a few months to a few years Lichen nitidus
  41. 41. Multiple, discrete, skin-colored, smooth, flat, round, pin point papules
  42. 42. Koebner’s phenomenon
  43. 43. 5. Lichen striatus
  44. 44. • Discrete and confluent papules • Linear arrangement • Arm or leg • Adolescent • Resolved spontaneously within a few months to a few years Lichen Striatus
  45. 45. 6. Exfoliative dermatitis
  46. 46. • Generalized erythroderma and scaling • No mucosal involvement • Dystrophic nail change • Alopecia in 25% of patients Exfoliative Dermatitis
  47. 47. Systemic manifestation • Lymphademopathy (50%) • Fever (temp < 38°c) • Raised basal metabolic rate & tachycardia • Anemia (60%), eosinophilia (35%) • Negative nitrogen balance, hypoalbuminemia Exfoliative Dermatitis
  48. 48. Causes • Exacerbation of pre-existing skin diseases • Drugs • Associated with underlying systemic diseases • undetermined Exfoliative Dermatitis
  49. 49. Treatments การรักษาโดยรวมของโรคผิวหนังกลุ่มนี้ • ลดการอักเสบใช้ steroid ในรูปทาหรือ systemic ตาม ความรุนแรงของโรค • ถ้าเป็นรุนแรงอาจมีการฉายแสงอาทิตย์เทียม ยา chemotherapy or vitamine A สังเคราะห์ • ลดอาการคันใช้ยา antihistamine • ยาอื่นๆเช่น น้้ามันมะกอก แชมพูTar LCD เป็นต้น
  50. 50. Scar
  51. 51. What is a Scar • result of the skin repairs wounds • a natural part of the healing process • may improve on their own over 6 to 18 months “The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar “
  52. 52. Classification of scar 1. Atrophic scar 2. Hypertrophic scar 3. Keloid
  53. 53. Atrophic scar
  54. 54. Hypertrophic scar
  55. 55. Keloid
  56. 56. Scar Treatments • Cosmetics • Pressure bandages and massages • Silicone-containing gels, creams, and bandages • Chemical Peels • Dermabrasion • Steroid injections • Cryosurgery • Surgical Scar Revision • Laser Resurfacing and Pulsed Dye Laser Scar Revision • Soft Tissue Fillers
  57. 57. เชิญทดสอบตนเอง โดยท้าแบบฝึกหัด “ทบทวนบทเรียน”
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Common skin diseases by Siriraj

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