- 1. Slides Interpretation for Diploma 2011 By Dr Wedad Bardisi
Consultant family physician
2. What is the diagnosis? 3. A stye or hordeolum
- is an infection of the sebaceous glands at the base of the
eyelashes. Styes are similar to chalazia, but tend to be of smaller
size and feel much more painful and usually produce no lasting
damage.
- Styes are generally caused by aStaphylococcus aureusbacterial
infection.
- Although they are particularly common in infants, styes are
experienced by people of all ages.
- Styes can be triggered by stress or poor nutrition. Using the
same razor to shave hair near both the eyes and a mustache can also
spread staphylococcus bacteria, potentially leading to styes or
other eye infections. The bacteria are contagious, so care should
be taken to avoid touching the eye or sharing cosmetics, towels, or
washcloths. Styes will last up to two and a half years without
treatment, with treatment anywhere between 8 months and a
month.
4.
- The first signs of a stye are tenderness, pain and redness in
the affected area. Later symptoms include itching, swelling,
watering of the eye, sensitivity to light and discomfort when
blinking.
- A yellowish bump sometimes develops in the affected area. This
can be found on the top, bottom, or any area pertaining to the
eye.
- While most styes will drain on their own, this process can be
accelerated by the application of a warm compress. There is also a
specialized Polysporin topical ointment for styes. With treatment,
styes typically resolve within one week.
- Lancing of a stye is not recommended without technical
expertise given its proximity to the eye. Styes may also cause a
bruised feeling around the eye, which can be treated through the
application of a warm cloth .
5. What is this? 6. A - chalazion
- Achalazionis ameibomian gland lipogranuloma , is a cystin the
eyelid that is caused by inflammationof a blocked meibomian gland
usually on the upper eyelid
- Chalazions differ from styes (hordeolums) in that they are
usually painless apart from the tenderness caused when they swell
up, and in size (chalazia tend to be larger than styes).
- A chalazion may eventually disappear on its own after a few
months, though more often than not, some treatment is
necessary
7.
- The primary treatment is application of warm compresses for 10
to 20 minutes at least 4 times a day.
- This may soften the hardened oils blocking the duct and promote
drainage and healing.
8. What is the diagnosis 9. Ectropion
- It is caused by a lack of tone of the delicate muscles that
hold the lid taut against the eye.
- Excessive tearing is a common with ectropion, but wiping the
tears away only causes the lid to sag more.
- Ectropion is most common among people over the age of 60.
10.
- Ectropion can be diagnosed with a routine eye exam .
11. What is the diagnosis? 12. Entropion
- Entropion , an eyelid that turns inward, is a problem that
typically affects the lower lid.
- It usually stems from a muscle spasm; however, it can also be
caused by scarring from trauma or inflammation from certain
diseases that involve the eyelids.
- When the eyelid turns inward, the lashes rub against the eye,
resulting in irritation, scratchiness, tearing and redness.
- Surgery is often required to correct the problem.
13. What is the diagnosis? 14. Xanthelasma
- Xanthelasma:is a sharply demarcated yellowish collection of
cholesterol underneath the skin, usually on or around the eyelids.
Although not harmful or painful, these minor growths may be
disfiguring andcan be removed with:
- trichloroacetic acid peel,
15.
- Removal can cause scarring and pigment changes, but it is
unusual after treatment with trichloroacetic acid.
- Because of the hereditary component, they may or may not
indicate high blood levels of cholesterol .
- Where there is no family history of xanthelasmata they usually
indicate high cholesterol and may correlate with a risk of
atheromatous disease
- High cholesterol levels (specifically
familialhypercholesterolemia)
- Primary biliary cirrhosis
16. What is the diagnosis? 17. Ptosis 18. Ptosis
- Ptosis or drooping of the upper eyelid, may occur for several
reason s such as: disease, injury, birth defect, previous eye
surgery and age.
- In most cases, it is caused bya weakness of the levator
muscle
- Children born with ptosis may require surgical correction of
the lid if it covers the pupil.In some cases, it may be associated
with a crossed or misaligned eye (strabismus).
- Left untreated, ptosis may prevent vision from developing
properly, resulting in amblyopia or lazy eye
19.
- The symptoms are dependent on the underlying problem and may
include:
- Drooping lid (may affect one or both eyes)
- Difficulty closing the eye completely
- Eye fatigue from straining to keep eye(s) open
- Children may tilt head backward in order to lift the lid
- Crossed or misaligned eye
20.
- Ptosis does not usually improve with time, and nearly always
requires corrective surgery by an ophthalmologist specializing in
plastic and reconstructive surgery. In most cases, surgery is
performed to strengthen or tighten the levator muscle and lift the
eyelid. If the levator muscle is especially weak, the lid and
eyebrow may be lifted. Ptosis can usually be performed with local
anesthesia except with young children .
21. What is the diagnosis? 22. Ptyrigum due to excessive sun
exposure treatment issurgical excision. 23. keratoconus 24.
- Keratoconus (KC) is a progressive, noninflammatory, bilateral
(but usually asymmetrical) disease of the cornea, characterized by
paraxial stromal thinning that leads to corneal surface
distortion.
- Visual loss occurs primarily from irregular astigmatism and
myopia and secondarily from corneal scarring .
25.
- Although not definitively identified, genetic inheritance;
systemic and ocular associations; eye rubbing; atopy, specifically
ocular allergies; and CL wear are proposed risk factors.
- Several reports suggest,coincidentally, associations with KC
and other corneal dystrophies .
26. Hyphema: blood in the anterior chamber due to trauma 27.
Subcongenctival haemorrhage spontaneous remmision 28. Corneal
abrasion 29. 30. 31. This 10-year-old boy this reaction to the
paraphenylenediamine pigment enhancer in a henna tattoo 3 weeks
after placement of the tattoo 32.
- Diagnosis is hypersensitivity reaction
- Avoid the causative lesion
- Treat with corticosteroids
33. CONTACT DERMATITIS 34. CONTACT DERMATITIS 35. Clubbing 36.
Cyanosis due to congenital heart disease 37. Acanthosis nigricans
38. Acanthosis Nigricans
39. Acanthosis nigricans 40. Atopic dermatitis 41. Atopic
dermatitis 42. Atopic dermatitis 43. Atopic dermatitis 44. Atopic
dermatitis
- There is quite a variation in the appearance of atopic
dermatitis between individuals. From time to time, most people have
acute flares with inflamed, red, sometimes blistered and weepy
patches. In between flares, the skin may appear normal or suffer
from chronic eczema with dry, thickened and itchy areas.
45.
- The presence of infection or an additional skin condition, the
creams applied, the age of the person, their ethnic origin and
other factors can alter the way eczema looks and feels.
- There are however some general patterns to where the eczema is
found on the body according to the age of the affected person.
46.
- Treatment of atopic dermatitis may be required for many months
and possibly years.
- It nearly always requires:
- Reduction of exposure to trigger factors (where possible)
- Regular emollients (moisturisers)
- Intermittent topical steroids
47.
- In some cases management may also include one of more of the
following:
- Topical treatment such as
- Pimecrolimus cream or tacrolimus ointment
48. This child developed high fever, developed this rash 4 days
ago 49. Oral examination of his mouth showed theselesions . What is
the diagnosis? 50. Diagnosis
- This patient has measles.
- Measles is an acute, highly communicable viral disease with
fever, conjunctivitis, coryza, cough, and Koplik spots.
- Koplik spots are small, red, irregularly-shaped spots with
blue-white centers found on the mucosal surface of the oral
cavity.
- Kopliks spotsdevelop on palate during the pre-eruptive measles
on day 3 of the illness .
51. Koplik spots 52.
- This individual with measles is displaying red Koplik spots on
his buccal mucosa during the 3rd day of the rash. Koplik's spots
occur 1-2 days before to 1-2 days after the cutaneous rash. Their
presence is considered to be pathognomonic for measles, and appear
as punctate blue-white spots on the bright red background of the
oral buccal (cheek) mucosa.
53. Measles 54.
- This child with measles is displaying the characteristic red
blotchy pattern on his body during third day of the rash.
- Measles is an acute, highly communicable viral disease with
prodromal fever, conjunctivitis, coryza, cough, and Koplik spots on
the buccal mucosa. A red blotchy rash appears around day 3 of the
illness, first on the face, and then becominggeneralized.
55. Measles 56. This presented with this sore lesion on his lip
what is the diagnosis? 57. Herpes Labialis, Herpes Simplex
- This is a herpes simplex lesion of the lower lip on the 2nd day
after onset.
- Also known as a cold sore, this lesion is caused by the
contagious herpes simplex virus Type-1 (HSV-1).
- The HSV-1 virus remains in the body throughout an exposed
persons entire life.
58. 59. Herpes simplex
- This patient presented with herpes simplex lesions around her
mouth due to the herpes simplex virus Type-1, (HSV1) pathogen.
- Herpes simplex virus type1 usually is the cause for oral
lesions sometimes referred to as cold sores, fever blisters or more
technically known as recurrent herpes labialis.
- Virus Diseases, Herpesviridae Infections, Herpes Simplex,
HerpesLabialis
60. Cold sores 61. What is the diagnosis? 62. Seborrheic
Dermatitis
- Common, chronic dermatosis of unknown aetiology, characterized
by scaling and redness occurring primarily in the areas with the
highest concentration of sebaceous glands, namely the scalp, face,
presternal and intertriginous areas.
- On the scalp, it generally appears first as small patches of
scales, progressing to involve the entire scalp with exfoliation of
excessive amounts of dry scales. It is very common during the
infancy age group, approximately 50 per cent of infantile cases
occur before 5 weeks of age.
- Seborrheic Dermatitis, Seborrheic Eczema, Dysseborrheic
Dermatitise
63. Seborrheic Dermatitis - 64. Seborrheic Dermatitis - 65.
Seborrheic Dermatitis - 66. What is this lesion? 67. Diaper
Dermatitis
- Variety of inflammatory disorders of the skin that occur on the
lower aspect of the abdomen, genitalia, buttocks, and upper portion
of the thighs initiated by a combination of factors, the most
significant being irritation by the urine and faeces, occlusion and
candida colonisation.
- Diffuse reddening of the skin with papules, vesicles, oedema,
and scaling of the involved areas as well as psoriasiform lesions,
secondary erosions, ulcerations and infiltrated nodules in more
severe cases may occur. Diaper dermatitis peaks between the ages of
6 and 10 months.
68. Diaper Dermatitis 69. What is thediagnosis ? 70. Pityriasis
Versicolor (TineaVersicolor)
- A common chronic, noninflammatory and usually symptomless
disorder, characterized by the occurrence of multiple macular
patches of all sizes and shapes, and varying in pigmentation from
fawn-coloured to brown.
- It is produced by the proliferation of the lipophilic yeast,
Malassezia furfur which is part of the normal flora of human
skin.
- It can but is most commonly seen in young adults and is
comparatively rare in children .
- Treatmenoccur at any age t antifungal cream and shampoo
71. What is the diagnosis? 72. Tinea Corporis( Ringworm of the
Body, Tinea Circinata)
- Dermatophyte infection of the skin including lesions of the
trunk and limbs.
- All known dermatophytes may produce lesions.
- Infection is acquired from an active lesion of an animal, by
direct human contact, or from soil.
- Spread from existing localized infection, e.g. feet, is not
uncommon.
- Characteristic lesions are circular and sharply marginated with
a raised edge.
- Scaling is a common but not constant finding.
- Lesions may also be eczematous, vesicular andpustular in
nature.
73. Tinea Corporis 74. Tinea Corporis 75. What is the diagnosis?
76. Pityriasis rosea 77. Pityriasis rosea
- Pityriasis rosea is a rash that occurs most commonly in people
between the ages of 10 and 35, but may occur at any age.
- The rash can last from several weeks to several months.
- Usually there are no permanent marks as a result of this
condition.
- It may occur at anytime of year, but pityriasis rosea is most
common in the spring and fall.
78. Signs and Symptoms
- Pityriasis rosea usually begins with a large, scaly, pink patch
on the chest or back, which is called a "herald" or "mother"
patch.
- It is frequently confused with ringworm, but antifungal creams
do not help because it is not a fungus.
79.
- Within a week or two, more pink patches appear on the chest,
back, arms, and legs. Patches may also occur on the neck, but
rarely on the face.
- The patches are oval and may form a pattern over the back that
resembles the outline of aChristmas tree .
- Sometimes the disease can produce a very severe and widespread
skin eruption.
80.
- About half the patients will have some itching, especially when
they become warm.
- Physical activities like jogging and running, or bathing in hot
water, may cause the rash to temporarily worsen or become more
obvious.
- There may be other symptoms including fatigue and aching. The
rash usually fades and disappears within six to eight weeks, but
can sometimes last much longer.
81. Treatment
- may include external and internal medications for itching.
- Aveeno oatmeal baths, anti-itch medicated lotions and steroid
creams may be prescribed to combat the rash.
- Warm, rather than hot, baths may be suggested.
- Strenuous activity, which could aggravate the rash, should be
discouraged.
- Ultraviolet light treatments given under the supervision of a
dermatologist may be helpful .
82.
- Recently, both the antiviral drug Famvir and the antibiotic
erythromycin have been claimed to produce healing in one to two
weeks.
- For severe cases a few days of oral anti-inflammatory
medications such as prednisone may be necessary to promote
healing.
- For mild cases, no treatment is required as this disease is not
a dangerous skin condition.
83. What is the diagnosis? 84.
- Cutaneous eruption characterized by discoid or coin-shaped
plaques of eczema.
- The lesions usually occur on the extensor surfaces of the
extremities, but the face and trunk may also be involved.
- The specific aetiology is unknown. However, it seems to appear
in a cold and dry environment and is aggravated by excessive
bathing and local irritants such as wool. Often, a heavy
colonisation of the lesions by staphylococci has been found.
85. Nummular Eczema, Eczema 86. Nummular Eczema, EczemaNails 87.
Dermatitis Herpetiformis 88. Dermatitis Herpetiformis 89.
Dermatitis Herpetiformis 90. Dermatitis Herpetiformis 91.
Dermatitis herpetiformis
- Dermatitis herpetiformis (DH) is an autoimmune blistering
disorder associated with a gluten-sensitive enteropathy
- It is characterized by grouped excoriations; erythematous,
urticarial plaques; and papules with vesicles.
- These are located on the extensor surfaces of the elbows,
knees, buttocks, and back. It is exquisitely pruritic, and the
vesicles are often excoriated to erosions by the time of physical
examination.
92.
- DH has recently been proposed as a cutaneous manifestation of
asymptomatic-to-mild Celiac Disease.
- The genetic predisposition to the development of gluten
sensitivity underlies the disease .
- Strict compliance with a gluten-free diet results in
normalization of the small bowel mucosal changes and control of the
cutaneous manifestations of DH in most patients .
93.
-
- Associated GI conditionsinclude gluten enteropathy, gastric
atrophy, gastric hypochlorhydria, and pernicious anemia.
-
- Associated autoimmune diseasesinclude dermatomyositis, type 1
diabetes mellitus, myasthenia gravis, rheumatoid arthritis, Sjgren
syndrome, systemic lupus erythematosus, and thyroid
abnormalities.
-
- Thyroid abnormalities are present in as many as 50% of DH
patients and include hypothyroidism, hyperthyroidism, thyroid
nodules, andthyroid cancer. .
94.
- Associated neoplastic conditionsinclude GI lymphomas and
non-Hodgkin lymphoma; patients are at increased risk of developing
these cancers. A gluten-free diet may reduce incidence of
DH-associated lymphomas
95. What is the diagnosis? 96. Epidermolysis Bullosa 97.
Epidermolysis Bullosa 98.
- Epidermolysis bullosa (EB) is a group of inherited bullous
disorders characterized by blister formation in response to
mechanical trauma.
- Epidermolysis bullosa (EB) is a genetic disease and no drugs
are known to correct the underlying molecular defects. Prolonged
use of steroids is contraindicated in the treatment of inherited
forms of EB.
- No other drugs, including phenytoin and tetracycline, have
improved the blistering or epithelial dis adhesion in EB
significantly or consistently.
99. Pemphigus 100. Pemphigus 101. GoutTophi 102. gout 103.
- The 40 year old female developed a papulosquamous eruption
beginning on her trunk and spreading to all four extremities. She
recently had a streptococcal infection, treated with
antibiotics
104. This is a classic history and shape ofguttate psoriasis .
105. acne 106. Acne 107. Acne 108. Acne Rosacea 109. Acne Rosacea
110. Acne Rosacea 111. Acne Rosacea 112. Acne Rosacea 113. Albinism
114. Alopecia areata 115. Alopecia areata 116. Alopecia areata 117.
Angiodema 118. Angiodema 119. Angiodema 120. Basal cell carcinoma
121. Basal cell carcinoma 122. Basal cell carcinoma 123. Behet's
Syndrome1 124. Behet's Syndrome1 125. Behet's Syndrome1 126.
Chancroid1 127. Cicatricial Pemphigoid2 128. Condyloma Acuminatum1
129. Drug reaction 130. Eczema Herpeticum1 131. Eczema Herpeticum1
132. Erysipelas 133. Erythema Annulare Centrifugum1 134. Erythema
Annulare Centrifugum1 135. Erythema Multiforme2 136. Erythema
Nodosum1 137. Newborn Skin:Common Rashes Cutis marmorata, a normal
reticulated mottling of the skin caused by vascular response to
cold. 138. Erythema toxicum neonatorum can result in a
"flea-bitten" appearance. 139. Acne neonatorum typically consists
of closed comedones on the forehead, nose, and cheeks. 140.
Clinical recommendation
- Infants who appear sick and have vesiculopustular rashes should
be tested forCandida , viral, and bacterial infections.
- Acne neonatorum usually resolves within four months without
scarring. In severe cases, 2.5% benzoyl peroxide lotion can be used
to hasten resolution.
- Miliaria rubra (also known as heat rash) responds to avoidance
of overheating, removal of excess clothing, cool baths, and air
conditioning.
141.
- Infantile seborrheic dermatitis usually responds to
conservative treatment, including petrolatum, soft brushes, and
tar-containing shampoo.
- Resistant seborrheic dermatitis can be treated with topical
antifungals or mild corticosteroids.
142. 143. 144. 145. 146.