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Acne Rosacea
This is a chronic skin disease of unknown cause in adults which characteristically affects the nose, cheeks and forehead, most often between the ages of 30-60.
– It is more common in white people with blue eyes, made worse by sunlight
Appearance
– Starts with flushing before giving persistent redness
– Gives pustule formation and prominent blood vessels (telangiectasia)
– Can lead to rhinophyma – bulbous nose due to chronic inflammation
Management
– Reduce the factors which cause flushing such as sun exposure
– Tetracycline antibiotics for 6-12 weeks –> doxycycline, minocycline
– If resistant –> co-trimoxazole or metronidazole
– If still persistent, try isotretinoin or vascular laser for persistent telangiectasia
Lichen Sclerosus
An inflammatory condition that usually affects genital and anal areas
– It is much more common in women and increases the risk of vulval cancer
– Can affect the penis ➔ called balanitis xerotica obliterans (BXO)
Appearance
– White, itchy, painful patches on the inner parts of the vulva
– Gives easier cracking, tearing and hyperkeratosis
– Urination might give stinging, and can also get superficial dyspareunia
Management
– Skin biopsy if woman does not respond to treatment or suspicion of cancer
– Once diagnosed, wash gently, use emollients to relieve dryness + topical steroid (Clobetasol)
Psoriasis
A disease where abnormal T cell activity gives excessive keratinocyte proliferation. There are 4 main subtypes:
i) Plaque ➔ most common type giving well defined red, salmon colour, scaly patches
– Seen on the extensor areas and the head
ii) Flexural ➔ Smooth well-defined plaques which are seen in body fold and genitals
iii) Guttate ➔ This is a type which occurs after a streptococcal infection
– Gives teardrop red lesions but usually self-resolves after a few months
iv) Generalised Pustular ➔ Gives flares of pustules superimposed of red painful skin
Symptoms
– Skin rash (red salmon coloured, scaly) on extensor surfaces, behind ears and on scalp
– Can have nail symptoms (pitting, onycholysis) + signs of psoriatic arthritis (joint pain, sausage fingers)
– Can be exacerbated by various factors –> Alcohol, Drugs (NSAIDs, Lithium and Beta-blockers, ACEi), injury
Management:
– 1st line is topical therapy –> Steroid cream + Vitamin D analogue (Calcitriol) for 4 weeks
– 2nd line (if no improvement after 2 months) –> Vitamin D analogue (reduces epidermis proliferation) twice daily
– If unresolving, phototherapy (Ultraviolet B light) or immunosuppressive e.g. oral methotrexate
– Specialist medication – Apremilast (PDE IV inhibitor) for refractory disease
Erythroderma
This is a widespread reddening of the skin due to an inflammatory skin disease.
– It is used when a rash involves > 90% of the skin
Causes: Previous skin disease (eczema, psoriasis), lymphoma, idiopathic
– Drugs –penicillin, sulphonamides
Appearance
– Skin appears red, warm, oedematous, scaly and very itchy
– Patients are systemically unwell with lymphadenopathy
– Can lead to secondary infection, fluid loss and hypovolaemic shock
Management
– Treat the underlying cause
– Emollients and wet-wraps to keep skin moist + topical steroids
