1. Common dermatology problems
Dr Ghada A. Bin Saif
Assisstant professor
Dermatology department
King saud university & KKUH

2. 2 w : enlarging eruption on trunk
15 year old
2 w : enlarging eruption on trunk

3. DIFFERENTIAL DIAGNOSIS
Tinea corporis (active edge)
Discoid eczema (numerous, symmetrical,
no central clearing)
Erythema annulare centrifugum
Granuloma annulare
Contact allergic dermatitis
Annular psoriasis
Pityriasis rosea
Seborrhoeic dermatitis

4. Erythema annulare centrifugum

5. Granuloma annulare

6. Tinea corporis management ? ?

7. SPECIAL STUDIES TREATMENT Scraping : KOH & fungal culture Isolated
Topical (Allylamines, imidazoles) BD X 2-4 WK
Widespread
Fluconazole 150 mg weekly x 2-4 w
Itraconazole 200 mg OD X w
Terbinafine 250 mg OD x w
Grisofulvin 500 mg OD x 2-4 w

8. 40 year old 2 year history of knees, elbows and truncal eruption

10. Plaque Psoriasis

11. Plaque Psoriasis management ?

12. Management of chronic plaque psoriasis
Education
Arthropathy ??
Scalp : CS scalp lotion, T gel shampoo
< 5 % BSA : topical -- Sequential therapy
- Diprolein oint & Daivonix
BD x 5d BD x 2d w
PM AM w
BD X 2d BD x 5d
- Tazarotene
- Salicylic a
>10 % : phototherapy or systemic ttt

13. Lichen Simplex Chronicus
55 year old
2 Y : very pruritic eruption on ankle
Lichen Simplex Chronicus

14. TREATMENT Stop itching + emollients
High potency topical CS +- occlusion
Diprolein oint BD
Dermovate oint BD
IL CS
Oral antihistamines ( Atarax)
?? Skin biopsy

15. 14 Y Old pruritic eruption in arm & legs flexors X ys worse in winter bronchial asthma intolerance to wool orbital darkening
Atopic dermatitis

18. 28 y old lady 9 m : pruritic hand eruption bilaterally

19. DIFFERENTIAL DIAGNOSIS
Contact dermatitis
Tinea mannum
Palmoplantar Psoriasis

20. Tinea mannum

21. Hand dermatitis management ? ?

22. SPECIAL STUDIES TREATMENT Patch test Scraping for KOH
Avoid ppt & Emollients
Potent topical CS
Oral antihistamine

23. 30 y old gentleman 6 y : recurrent pruritic sole eruption bilaterally

24. DIFFERENTIAL DIAGNOSIS
Dyshidrotic eczema
Allergic contact dermatitis
Tinea pedis
Pustular psoriasis

25. Contact dermatitis

26. Tinea Pedis

27. Pustular psoriasis

28. Dyshidrotic eczema management ? ?

29. DYSHIDROTIC ECZEMA SPECIAL STUDIES Scraping for KOH Patch test
TREATMENT
Oral antihistamine
Potent topical CS
Botox inj
Systemic therapy

31. DIFFERENTIAL DIAGNOSIS (localized)
Depigmented:
- Vitiligo ( acquired, pattern of depigmentation)
- Piebaldism (birth, AD, site, Pig ,S, white forlock)
- Chemical leucoderma
Hypopigmented :
- Tuberous sclerosis (birth, S , lance-ovate)
- Nevus depigmentosus (birth, S, unilateral)
- Post Inflammatory Hypopigmentation
- Pityriasis alba (scales)
- MF
Nonmelanotic :
- Nevus anaemicus (S)

33. Tuberous sclerosis

34. Nevus depigmentosus

35. Nevus anaemicus

36. Post Inflammatory Hypopigmentation

37. Pityriasis alba

38. Vitiligo management ??

40. Limited Vitiligo SPECIAL STUDIES
T4, TSH, FBS, ANA/Ro/La (prior to PUVA)
TREATMENT
Sunscreen (sunburn, koebnerization, tanning)
Class 3 topical GC
OD x3w - skip a week.
Monitor for SE: 2 m
Topical Tacrolimus
Topical PUVA
Excimer laser
Resistant, Stable of 2 years : Surgical

41. Management ?

42. 25 year old gentleman 2 years: facial , upper back eruption

43. DIFFERENTIAL DIAGNOSIS
Acne vulgaris ( comedons)
Steroid induced acne ( monomorphic)
Papulopustular Rosacea ( centrofacial, erythema, telangiectasia )
lupus miliaris disseminata faciei
Perioral dermatitis
Folliculitis
Pseudofolliculitis barbae

44. Acne Vulgaris Moderate papulopustular

45. Comedonal acne

46. Nodulocystic acne

47. Scars

48. Drug Induced Acne

50. SPECIAL STUDIES When suspected ? ?
- Testosterone, prolactin, FSH/LH, DHEAS, Scan ovaries
- Morning cortison, 17a-OH Progesterone
Roaccutane: Preg. Test, LFT, Lipid
Minocycline : ANA, LFT AT 6-8 m

51. TREATMENT Mild : Topicals Comedonal : retinoids
Inflammatory: Abx, BP, azelic a
Combined
Moderate : Oral Abx (6-8 m) + topical keratolytic
Tetracyclines (Doxycycline, minocycline)
Female: Dianette + topical or oral Abx
Older women: spironolactone
Severe (physically, psychologically, failure to respond, scarring, GNF ): Oral isotretinoin
Maintainance therapy ? ? ?

52. How to use oral isotretinoin ? ?
Lab
No pregnancy
Dose : mg/kg/d
Cumulative dose : mg/kg
LFT + lipid monthly
Fixed dose: 2 test normal : No more test
Refresh eye drops
Emollients ( lips)

53. 70 year old 5 year: facial flushing & eruption and eye redness No ttt use before
Papulopustular Rosacea

56. Pseudofolliculitis barbae
30 year old 3 year: facial eruption, increased after shaving
Pseudofolliculitis barbae

58. Retinoic a Glycolic a Laser depilation

59. 60 year old 4 year: oily face facial and scalp eruption
Seborrhoeic Dermatitis

60. TREATMENT Scalp : - shampoo ( ketoconazole, salicylic a,
selenium sulfide)
- Glucocorticoids scalp lotion
Face & trunk: -Low potency topical GC
-Topical imidazoles (ketoconazole)
Resistant: Oral ketoconazole or itraconazole (2-3w)

61. 25 Year old lady 1 m: localized hair loss

62. DIFFERENTIAL DIAGNOSIS (acquird, localized)
Alopecia Areata
Tinea capitis
Trichotillomania
Scarring alopecia

63. Tinea capitis (Gray patch)

64. Trichotillomania

65. Scarring alopecia ( Lichen planopilaris)

66. Alopecia areata management ? ?

67. SPECIAL STUDIES
CBC, TFT, antibodies, serum B12
PROGNOSTIC FACTORS
- young (<5y)
- Severity
- Ophiasis
- Duration before ttt
- Nail changes

68. TREATMENT Observation Intralesional CS ( TA 2.5-5 mg/ml-- /m)
Potent topical CS ( with occlusion)
Anthralin , retinoic a
Topical minoxidil
Systemic CS
PUVA

69. 6 Y old boy 3 weeks : localized hair fall

70. DIFFERENTIAL DIAGNOSIS
Tinea capitis (kerion)
Bacterial pyoderma
Folliculitis decalvans
Perifolliculitis capitis abscedens et suffodiens

71. Tinea capitis (kerion) management ??

72. SPECIAL STUDIES Hair pluck and scales: KOH & fungal culture
Wood’s lamp

73. TREATMENT Education Ketoconazole shampoo Systemic antifungal
Grisofulvin (ultamicrosized 10-15mg/kg/d)
500mg PO OD X 6-8 w
Itraconazole (5mg/kg/d)
200mg BD X 4-8w OR 3 pulses
Terbinafine (5mg/kg/d) 250mg OD X 2-4w
Fluconazole 6mg/kg/d X 3-6w
Prednisolone 1 mg/kg/d X 2w

74. 19 year old 3 m : pruritic, short lived, recurrent eruption
Chronic urticaria

76. SPECIAL STUDIES Unnecessary for acute urticaria
CBC ,Blood eosinophilia
Stool examination
ESR
Thyroid autoantibodies

78. 45 y old 1 Y : finger and toe nail discoloration

79. DIFFERENTIAL DIAGNOSIS
Onychomycosis
Psoriasis
Lichen planus
Hyperthyroidism
Trauma
Pachyonychia congenita

82. 5d: Fever, joint pain, painful eruption on both chins
29 Y old lady
5d: Fever, joint pain, painful eruption on both chins
Erythema Nodosum

84. SPECIAL STUDIES
ALL :ASO titer, throat culture, CXR, PPD
TREATMENT
Bed rest
NSAID (Indomethacin 25mg PO TID )
KI (super sat. sol.)5 drops TID
Colchicine 1mg OD
Hydroxychloroquine 200mg PO BD
Prednisolone

85. Striae treatment ??