dermatology and heptobilliary *

Herpetic Gingivostomatitis

Primary HSV 1 infection commonly seen in ages 1 to 5.

Herpetic Whitlow

Recurrent HSV 1 on the finger.

Herpes Zoster

Shingles developed in patients who have previously had Chickenpox due to the Varicella Zoster Virus.

Zoster Mouth Blistering

Occurs if the Trigeminal Nerve is affected.

Common Sites for Herpes Zoster

Chest, Neck, Lumbar/Sacral Regions.

Acyclovir dosage for Herpes Zoster

800mg 5 times Daily for 7 days.

Herpes Zoster Ophthalmicus

Shingles in the Ophthalmic Division of the Trigeminal Nerve with unilateral distribution.

Hutchinson's Sign

A zoster infection with trigeminal eruption including the tip of the nose indicating Nasociliary Nerve Involvement.

Molluscum Contagiosum

Common Skin Infection caused by the Pox Virus causing Reactionary Epithelial Hyperplasia.

Transmission of Molluscum Contagiosum

Direct Contact and Vectors like Towels, Flannels, Toys, and Clothes.

Incubation Period for Molluscum Contagiosum

7 weeks from Initial Infection.

Clinical Appearance of Molluscum Contagiosum

Flesh Coloured to Pink, umbilicated and pearly surface, around 1 to 5 mm, may become itchy or sore.

Common organisms causing Cellulitis

1. Streptococcus Pyogenes, 2) Staphylococcus Aureus.

Clinical Presentation of Cellulitis

Unilateral, skin becomes red and inflamed, warm to touch, painful upon palpation, erosion, abscesses, systemically unwell.

Erysipelas

Superficial type of cellulitis caused by bacterial infection involving lymphatics with raised and sharply demarcated margins.

Organisms causing Erysipelas

Almost all cases caused by Group A Beta-Haemolytic Streptococci (S.Pyogenes).

Clinical Presentation of Erysipelas

Skin appears dimpled like orange skin with characteristic butterfly distribution.

Acne Vulgaris

An inflammatory disease of pilosebaceous follicle.

Acne Vulgaris causes

Blockages in skin hair follicles due to increased sebum production, keratin plugging, colonisation by C.Acnes bacteria, local inflammation.

Clinical Presentation of Acne Vulgaris

Non-inflammatory lesions (blackheads and whiteheads) and inflammatory lesions (papules, pustules, nodules, cysts).

Management of Mild Acne

1. Topical Antimicrobial Agents, 2) Low Dose Combined Oral Contraceptives for Women, 3) Topical Retinoid Agents.

Atopic Dermatitis (Eczema)

Chronic, itchy skin condition common in children, associated with atopic tendency.

Aetiology of Atopic Dermatitis

Inherited abnormalities in skin barrier, immune factors, microbial imbalances, external factors, skin irritants, stress.

Filaggrin

Filament-associated proteins binding to keratin fibres in epidermal cells, abnormal filaggrin linked to severe atopic dermatitis.

Signs and Symptoms of Atopic Dermatitis

Itchy, erythematous, dry scaly patches; acute lesions become vesicular and weepy; chronic lesions become excoriated and lichenified.

Psoriasis

Chronic inflammatory skin condition characterised by defined red and scaly plaques.

Causes of Psoriasis

Genetics (HLA subtype), immunological factors, environmental factors.

Management of Psoriasis

Avoid precipitating factors, use emollients, topical agents, phototherapy, and systemic treatments.

Seborrhoeic Keratosis

A benign overgrowth of the basal cell layer of the epidermis.

Aetiological Associations of Seborrhoeic Keratosis

Skin friction, genetic factors, sun exposure, possible local inflammatory response.

Spider Telangiectasia

A benign skin condition known as Spider Naevus or Spider Angioma.

Pyogenic Granuloma

Common benign lesion associated with hormonal influences and often indicated by trauma to the skin.

Chondrodermatitis Nodularis Helicis

Benign inflammatory condition affecting the skin and cartilage of the ear due to pressure and compromised blood supply.

Clinical Presentation of Chondrodermatitis Nodularis Helicis

Firm, oval-shaped nodules on the ear with central crusting and surrounding erythema.

Signs and Symptoms of Epidermoid Cysts

Normal or slightly pink skin, mobile over deeper layer, central punctum may express bad-smelling cheesy debris.

Solar Lentigo

Liver spots caused by prolonged UV light exposure and sun damage.

Actinic Elastosis

Accumulation of abnormal elastin in dermis due to prolonged sun exposure.

Signs and Symptoms of Actinic Elastosis

Thickened, dry, wrinkled, and furrowed skin.

Actinic Keratosis

Pre-malignant lesion, flat, scaly area with red edges, risk of transformation in 20% to Squamous Cell Carcinomas.

Risk Factors of Actinic Keratosis

Cumulative UV exposure, Fitzpatrick skin types I and II, long hours outdoors or tanning beds, immunosuppression.

Basal Cell Carcinoma

Most common form of skin cancer, locally invasive malignant tumours that are slow growing.

Risk Factors for Basal Cell Carcinoma

Cumulative UV exposure, previous skin cancers, pre-existing actinic keratosis or elastosis, repeated sunburn episodes.

Subtypes of Basal Cell Carcinomas

1. Nodular, 2) Superficial, 3) Morphoeic.

Nodular Basal Cell Carcinoma

Most common type, shiny skin-colored nodule, smooth surface, may ulcerate.

Superficial Basal Cell Carcinoma

Common in younger adults, slightly scaly and irregular plaque.

Morphoeic Basal Cell Carcinoma

Waxy scar-like plaque, indistinct borders, deep subclinical extension.

Management for Superficial Basal Cell Carcinomas

Cryotherapy, curettage, topical chemotherapy creams.

Management for High Risk Basal Cell Carcinomas

Mohs micrographic surgery, lesioned tissue excision, radiotherapy.

Squamous Cell Carcinoma

Locally invasive, malignant tumour of epithelial keratinocytes caused by UV radiation.

Signs and Symptoms of Squamous Cell Carcinomas

Ill-defined nodules, lesions grow in size, may ulcerate or necrose.

Malignant Melanoma

Invasive malignant tumour of epidermal melanocytes.

Risk Factors for Malignant Melanomas

UV exposure, Fitzpatrick skin types I and II, multiple or atypical moles, history of melanomas.

Lichen Planus

Autoimmune inflammatory mucocutaneous condition, often involves oral mucosa.

Sites affected by Oral Lichen Planus

Buccal mucosa and tongue with bilateral lesions.

Clinical Subtypes of Lichen Planus

1. Reticular, 2) Plaque-like, 3) Atrophic, 4) Erosive, 5) Papular, 6) Bullous.

Presentation of Lichen Planus

Violaceous, flat-topped, papules with Wickham's striae.

Pemphigus

Autoimmune disease with antibodies against desmosomes, leading to blistering.

Auto-antibodies in Pemphigus

Target Desmoglein I and III.

Intraoral Presentation of Pemphigus

Irregular ulcers with ragged edges, extremely fragile lesions.

Nikolsky Sign

Sign indicating dislodgment of normal epidermis and blister extension upon lateral pressure.

Pemphigoid

Autoimmune blistering disease with autoantibodies attacking basement membrane proteins.

Types of Pemphigoid

1. Bullous Pemphigoid, 2) Mucous Membrane Pemphigoid, 3) Gestational Pemphigoid.

Oral Presentation of Pemphigoid

Intact bullae leading to ragged erosions in the elderly.

Skin Presentation of Pemphigoid

Itchy urticarial rash progresses to bullae formation.

Dermatitis Herpetiformis

Cutaneous manifestation of coeliac disease, characterized by IgA deposition.

Oral Presentation of Dermatitis Herpetiformis

Fragile vesicles and keratotic patches, often with ulcerations.

Skin Presentation of Dermatitis Herpetiformis

Symmetrical vesicles on scalp, elbows and knees, often causing intense itching.

Epidermolysis Bullosa

Chronic, inherited skin disease characterized by blistering.

Oral Presentation of Epidermolysis Bullosa

Very fragile oral mucosa; painful erosions.

Skin Presentation of Epidermolysis Bullosa Simplex

Bullae on hands and feet, thickened plaques on palms and soles.

Skin Presentation of Junctional Epidermolysis Bullosa

Widespread bullae at birth leading to early infancy death due to sepsis.

Skin Presentation of Dystrophic Epidermolysis Bullosa

Blistering of large skin areas, scarring, fusion of fingers.

Systemic Sclerosis

Autoimmune disorder causing tissue fibrosis and skin hardening.

Subtypes of Systemic Sclerosis

1. Limited Cutaneous, 2) Diffuse Cutaneous, 3) Scleroderma.

Systemic Lupus Erythematous

Chronic autoimmune inflammatory disease affecting skin and organs.

Oral Presentation of Systemic Lupus Erythematous

Erythematous patches and oral ulceration.

Skin Presentation of Systemic Lupus Erythematous

Malar rash sparing nasolabial folds and triggered by sunlight.

Discoid Lupus Erythematous

Chronic inflammatory condition limited to skin without systemic effects.

Oral Presentation of Discoid Lupus Erythematous

Rare white papules with central erythema.

Skin Presentation of Discoid Lupus Erythematous

Scaly erythematous papules that may scar.

Oral Presentation of Palmoplantar Keratoderma

High arched palate and hyperkeratotic mucosal plaques.

Darier's Disease

Genetic skin disorder causing fragile cell adhesion leading to skin lesions.

Oral Presentation of Darier's Disease

Asymptomatic white patches affecting palate and buccal mucosa.

Type I Hypersensitivity reactions

Mediated by IgE.

Type IV mediated Hypersensitivity Reactions

Mediated by T Lymphocytes.

Severe Symptoms of Type I Hypersensitivity

1. Increased vascular permeability; 2) Airway constriction; 3) Angioedema; 4) Cardiovascular collapse; 5) Anaphylactic shock.

Oral manifestations of Erythema Multiforme

Widespread painful mucosal blistering and haemorrhagic crusting.

Viruses causing Liver Disease

Hepatitis B and C.

Role of the Liver

Produces bile, excreted into the bile duct and duodenum.

Liver Disease and Hemolytic Anemia

Red blood cells break down more easily, increasing turnover.

Splenomegaly in Haemolytic Anemia

The spleen enlarges due to increased turnover of red blood cells.

Disadvantage of Spleen Removal

Weakens the immune system.

Liver Size in Liver Disease

Liver can shrink due to less tissue available.

Cirrhosis

Scarring of the liver.

Cirrhosis vs Healthy Liver

Cirrhotic liver is rough with nodules, healthy liver is smooth.

How Cirrhosis Occurs

Continuous long-term damage to liver cells leads to fibrosis.

Hepatitis A

Causes acute liver infection; the immune system clears the virus.

Alcohol's Effect on the Liver

Alcohol can damage the liver, possibly leading to cirrhosis.

Consequences of Cirrhosis

1. Liver failure; 2) Portal hypertension; 3) Ascites; 4) Hepatocellular cancer.

Effects of Portal Hypertension

Varices, peptic ulcers, splenomegaly, ascites, and hemorrhoids.