Common Skin

diseases
Tutorial – 6G
Dr Dindar S QURTAS
MD, Ph.D., Assist Prof/ Dermatologist
Hawler Medical University/ College of Medicine
17/09/2020
Which is the commonest disease you
faced in your training in
dermatology?
A. Scabies
B. Wart
C. Psoriasis
D. Atopic dermatitis
E. Urticaria
Psoriasis
• It is a chronic non-infectious inflammatory skin disorder, characterized by well-
defined erythematous plaques bearing large adherent silvery scales.

• 1-3% of populations have psoriasis.

• It can start at any age, but is rare under 10 years, and appears most often between 15
and 40 years.

• Is usually chronic with exacerbations and remissions

Psoriasis (etiology)
• The precise cause of psoriasis is still unknown.

• Often a genetic predisposition,

• Environmental trigger.
Psoriasis (Topical treatments)
• Potent corticosteroids creams and oints.

• Vitamin D analogues (Calcipotriol), used in mild & moderate psoriasis.

• Topical retinoids (Tazarotene).

• Coal tar preparations

• Ultraviolet radiation: 2-3 times weekly for 8 weeks.

Psoriasis (systemic treatments)
• Retinoid (acitretin)

• Methotrexate

• Cyclosporine

• Psoralen & ultraviolet A (PUVA) treatment

• Biological agents (inflaximab, etanrecept)

Atopic Dermatitis (AD)
• Is chronic inflammatory
skin condition
characterized by priritus,
and a chronic coarse of
exacerbation and
remission, associated with
other allergic conditions
e.g;asthma ,….
Atopic Dermatitis (AD)
• We must have 3 major and
3 minor criteria
Atopic Dermatitis (Treatment
• Emollients and moisturizers to hydrate dried skin

• Topical steroid cream or ointments according to lesions status

(twice/day)

• Antihistamines (Chlorpheneramine, Loratadine, Levocititrizine tab) at

night up to 14 days

• Systemic steroids (tablet or injection) if very extensive process

 What is the main symptom in the Atopic
dermatitis?
A. Skin rash
B. Itching
C. Dryness
D. Erythema
E. Shortness of breath
Seborrheic Dermatitis
• SD is a chronic, superficial
inflammatory skin disease
characterized by a yellow, greasy
scaling on an erythematous base

• Predilection of areas of
sebaceous gland existence

• Associated with variable itching.

Seborrheic Dermatitis
(Treatment)
• Antifungal cream and shampoo
(Ketoconazole or Miconazole).

• Mild to moderate potency steroid

(Mometason and betamethasone)

• Antihistamine for allegry and itching

• In extensive cases Isotretinoin

tablets low dosage for 3-4 months
Contact Dermatitis (CD)
• Irritant CD: its eczematous skin
inflammation restricted to the site of
contact to irritants. E.g. detergents,
plants, plaster, cements, gloves, etc)

• Allergic CD: the eczematous

reaction occurs distant to the site of
the contact. E.g. hair dyes, diet
Irritant CD to gloves
allergy, …)
Contact Dermatitis (Tretment)
• Topical steroid moderate – high
potency (Betamethasone, clobetasole
propionate)

• Antihistamines orally (allermine,

loratidine, levocitirizine tab at night
for 10-14 days)

• Systemic steroids (tab or injection) Allergic CD to Hair dyes

whenever its extensive
Urticaria (Wheals!)
• Characterized by blanching, raised,
palpable wheals, which can be
linear, annular (circular), or arcuate
(serpiginous).

• Occur on any skin area and are

usually transient ( <24 hrs) and
migratory.
Urticaria (Angioedema)
• Angioedema (subcutaneous
swellings) may accompany the
wheals, may target the GIT and
respiratory tracts, resulting in
abdominal pain, SOB, and airway
obstruction.

• Anaphylaxis and hypotension may

occur.
Urticaria (Wheals!)
• ACUTE URTICARIA:- evolves over
days to weeks with complete
resolution within 6 weeks.

• CHRONIC URTICARIA:- more

than 6 weeks. Predominantly affects
adults and more common in females.
Urticaria (Etiological factors)
• Drugs e.g β-blocker ,aspirin,…

• Food ; e.gchocolate ,shellfish, nut,

peanut,tomatoes,

• Strawberries,melons,pork,cheese, milk, and

spices.

• Food additives:-yeast, citricacid, benzoate, etc….

• Infection:-e.g URTI by strept infection,chronic

viral infection(hepatitis B), infectious
mononucliosis, H. pylori
Urticaria (Treatment)
• Acute urticaria: avoidance of triggering factors.

• Antihistamines tablets (main stay of treatment): (H1

blockers) e.g; loratidin, desloratidine, fexofenadine,
cetirizine, levocetirizine, hydroxyzine….

• We douplicate doseage if no resposne

• Combine H1 & H2 blockers (cimitidine, ranitidine)

if no response

• If still no response addition of short course of

systemic steroids (prednisolone tab 20 mg/ twice
daily)
Urticaria (Treatment)
• In case of angioedema:

• Check for ABC (airway, breathing and BP),

as anaphylaxis could happen.

• Management of ABC if any compromise

available.

• If anaphylaxis is commencing then

adrenaline subcutaneous is given as life
saving action!

• When patient become stable follow usual

regimen of Urticaria treatment
Scabies
• parasitic infestation of the skin caused
by a mite Sarcoptes scabiei var. hominis.

• It is characterized by a pruritc papules,

vesicles , furrows and burrows.

• Any age

• Sex incidence is equal

• Axillae, groin, interdigital webs, peri-

umblical area are predilection sites
Scabies
How the personal bed stuff and clothes
can be disinfected for Scabies?
A. Boiling the clothes
B. After washing exposing to sun for 3
days
C. Usual wash and just isolation of dried
clothes for 3-7 days without sun
exposing
D. Use of disinfectant like Dettol
E. No way to disinfect, throw the clothes.
Scabies
The incidence of scabies is increased in:

• Overcrowded societies (poverty

and poor hygiene).

• Refugees camps

• Mentally-defective institutions.

• Prisons, jails

• War conditions
Scabies
• Is highly contagious

• So all family members could be

affected

• Sever itching specially at night, after

covering with blankets and the body
become wormed.

• In infant and early childhood

predilection site is palms and soles that
would not be involved in adults
Scabies (treatment)
Scabicidal agents (options):

• Permethrin cream (5%) application at night all

over the body, except the face and scalp. For 12
hrs. Reapplication after 7 days.

• Sulfur cream (10-20%). Applied to all body

except face and scalp. Every body application for
3 successive days. Then one application after 7
days.

• Benzyle Benzoate solution: the same way as

Sulfur.

• In refugees camp, prison or failure to above

Scabies (treatment)
Other measures:

• Antihistamines (tab) are given at night for at least

10-14 days.

• Sometimes after antiscabetic treatment itch

persists, it means that class IV hypersensitivity.
This needs systemic steroid short course
(prednisolone tab)

• All possesions of the patients (clothes, blankets,

bed sheets,…) should be washed with usual
procedure (Not boiling!!!) and then to be dried as
usual (Not under sun rays!!!) But left not used for
3-7 days to be sure that scabies parasite been died
 Human Papilloma virus
(warts)
• Small tumors of different sizes, colors, numbers,
and shapes, hard and solid with irregular, rough,
mamillated surface.

• skin coloured, brown, and dark brown.

• Symptomless except for plantar wart (painful on

stepping).

• Verroucous and bleeding points on scraping are

charecteristic of all warts

• They are self-limited and spontaneously

disappear, but in some case might prolog for up
to several years (7-10)
Human Papilloma virus
(warts)
Mode of spread:

• Direct contact: either breeches in skin or

mucous membrane.

• Common baths—(swimming pools).

• Sexual contact: genital warts( its regarded

as STI).

• Direct inoculation

• Autoinoculation: e.g shaving, along lines

of injures or wounds (koebner’s
phenomenon).
Human Papilloma virus
(warts)
Generally HPV virus causes hyperplasia in
epidermal keratinocytes so it forms these
papular lesion (wart)

Clinical types:
1. Common warts (verruca vulgaris)
2. Plane warts: usually on face and hands
3. Filliform warts(Digitate warts)
4. Plantar warts, Mosaic warts
5. Peri-and subungual warts.
6. Venereal warts (condylomata accuminata) that
have potentiality to change to SCC
Human Papilloma virus
(warts)
Treatment:
A. Destructive methods:

1. Chemical: using caustics such as TCA

50%, salicylic acid and lactic acid in
plaster or liquid forms.

2. Electrocautery.

3. Cryotherapy with liquid nitrogen

(freezing)

4. Laser.

5. Surgical removal.
Human Papilloma virus
(warts)
Treatment:
B. Chemotherapy: They are antimitotic
agents

1. Retinoic acid cream for plane warts.

2. 5 flouro-uracil cream

3. Imiquimod cream 5%

4. Podophyllotoxin solution (25%) .

5. formeldehyde or formalin ointment or

solution in plantar warts.
Can virus be (wart) be treated by acyclovir
or other antiviral agent available?

A.Yes

B.No