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Saturday, June 14, 2014

Parapsoriasis - What Is It?

A continuum is thought to exist: 
Chronic dermatitis ---> Parapsoriasis ---> T cell lymphoma (mycosis fungoides)



Parapsoriasis may be defined thus

1. Plaque-type (usually elderly and on legs; circinate patches may be red, yellow, brown, pink; plaques tend to be thin)
    (sometimes called chronic scaly superficial dermatitis)
.. Small plaque
.. Large plaque

2. Lichenoid
.. Pityriasis lichenoides
.... acute
.... chronic


Most cases aren't painful or itchy


If this is part of DDx -> consider punch biopsies to exclude a T cell lymphoma
Else histology changes tend to be non-specific


Emollients very important to hydrate skin
Otherwise,Rx tends to be that for dermatitis, including topical c.steroids and UV therapy


Always a good reference site, I find ...
emedicine.medscape.com/article/1107425-overviewApr 19, 2013 - Parapsoriasis describes a group of cutaneous diseases that can be characterized by scaly patches or slightly elevated papules


DDx includes
- dermatitis (particularly circinate/nummular type)
- psoriasis (plaque or guttate form)
- T cell lymphoma (mycosis fungoides)
- Pityriasis rosea
- Syphylis (secondary)



--> biopsies
--> ?syphylis serology






Saturday, February 23, 2013

Skin Grafts

Two Broad Types

1. Full thickness
= epidermis + dermis (all of it)
Note!
Don't include fat

2. Partial ("split") thickness
= epidermis + part of dermis
And, again: no fat!

Skin Closure after Surgical Excision of Skin Lesion

Techniques to consider in order of preference (a guide only):
Most common technique
= primary closure
[Don't forget secondary closure - not 2nd on list, but not to be forgotten]
Then
- skin graft (split/not full thickness)
Flaps
- advancement
- rotational
- transformational
Finally
- skin graft (full thickness)

Dry Skin May Only Require Hydration with Emollients rather than Topical C.steroids

Dry skin is not necessarily inflamed

Emollients (good [greasy] ones) are essential and may be all that is required

However, [appropriately potent] topical c.steroid should be available

Saturday, June 30, 2012

Molluscum contagiosum Rx


Rx
  • EMLA cream 60 mins prior to Rx (especially in children)
  • Curettage
  • or
  • Umbilicate


Other topical Rx messy, expensive and far less effective




NB:
  • In cases of dermatitis, ensure this is treated too as MC more likely to spread
  • Also, avoid baths to reduce risk of spread

Thursday, June 28, 2012

Vit D Deficiency

People with dark skin at higher risk for vitamin D deficiency versus people with light skin

Saturday, April 7, 2012

The Common Systemic Therapies


In psoriasis
  • 1. methotrexate
  • 2. acitretin
  • 3. cyclosporin
  • DON'T USE SYSTEMIC STEROIDS
In dermatitis (atopic)
  • 1. prednisolone
  • 2. methotrexate
  • 3. cyclosporin
  • 4. azothioprine - but evidence-base for efficacy and side effects is weak
Prednisolone
  • side-effects
    • endocrine or metabolic
      • osteoporosis
      • diabetes
      • e.lyte imbalance
      • acute adrenal insufficiency (on withdrawal)
    • hypertension
    • ocular
      • glaucoma
      • cataracts
Methotrexate
  • not sure how it works ?immune suppression
  • taking folic acid tabs. for part of week may help ↓anemia incidence
  • side-effects
    • nausea
    • diarrhoea
    • mouth ulcers
    • skin side-effects uncommon
    • More serious
      • hepatitis
      • cytopenia
      • teratogenesis
  • Pre-Rx check
    • FBC
    • LFTs
    • UCEs
    • eGFR
Acitretin
  • ↓cell proliferation
  • LFT changes uncommon
  • TG changes common (↑serum TGs)
  • side-effects
    • skin side-effects common
      • dry, red skin/nose;eyes; lips
        • →artificial tears for eyes
        • cheilitis --> consider barrier ung; UV protection
    • alopecia
    • photosensitivity
    • more serious
      • hepatitis
      • cytopenia
      • teratogenesis
In pregnant woman or woman planning pregnancy or breastfeeding
  • don't use
    • MTX
      • and until 3/12 after MTX ceased
    • tetracyclines
    • oral retinoid
      • isotretinoin
      • acitretin (and no pregnancy within 2 years)
Cyclosporin
  • ↓inflammation
  • only use under guidance of specialist experienced in its use
  • side-effects
    • hepatitis
    • renal dysfunction
    • gum hyperplasia: swollen or bleeding gums can occur --> dental hygiene
    • hirsuitism
    • Pre-Rx check
      • FBC
      • LFTs
      • UCEs
      • eGFR
      • F.lipids
      • Blood pressure
    • If BP raised --> consider calcium antagonist to prevent renal loss
So, for MTX, retinoids and cyclosporin
- Pre-Rx check
  • BP
  • FBC
  • LFTs
  • UCEs
  • eGFR
  • (F.lipids)
  • (pregnancy test in females)
- during Rx check
  • BP
  • FBC
  • LFTs
  • UCEs
  • eGFR
So, for prednisolone
- Pre-Rx check (ideally)
  • BP
  • UCEs
  • eGFR
  • F.lipids and F.BSL
  • Intra-ocular pressure
- during long-term Rx check
  • BP
  • UCEs
  • F.lipids and F.BSL
  • bone density
  • eyes
    • intra-ocular pressure
    • lens ?cataracts
Biological Rx
  • target T-cells or tumour necrosis factor alfa (TNF alfa)
  • expensive and strictly limited
  • can reactivate TB
  • → before Rx → QuantiFERON-TB Gold test
    • indirect test for M.tuberculosis
Preg code X
  • oral retinoids
    • isotretinoin
    • acitretin
  • MTX