SKIN CONDITIONS

Dr. S. M’bayo
Description of skin lesions
• PRIMARY MORPHOLOGY
• Macule: a flat lesion, less than 1cm, without elevation or depression
• Patch: a flat lesion greater than 1cm, without elevation or depression
• Plaque: a flat, elevated lesion, usually greater than 1cm
• Papule: elevated, solid lesion less than 1cm
• Nodule: elevated, solid lesion greater than 1cm
• Vesicle: elevated, fluid-filled lesion, usually less than 1cm
• Pustule: elevated, pus-filled lesion, usually less than 1cm
• Bulla: elevated, fluid-filled lesion, usually greater than 1cm
• Picture
Skin conditions that cause itching
• Scabies
• Onchocerciasis
• Fungal infection
• Urticaria
• Larva migrans
Scabies
• An itchy skin condition caused by a tiny burrowing mite called
Sarcoptes scabei
• Caused by close physical contact, or sharing clothing or bedding with
an infected person.
• The female mite burrows just beneath the skin and produces a tunnel
in which it deposits eggs. The eggs hatch in 3-4 days and the mite
larvae work their way to the surface of the skin where they mature
and can spread to other areas of the skin or the skin of other people.
• Itching is as a result of the body’s allergic reaction to the mites, their
eggs and their waste
• Common sites of infestation include:
• Scalp
• Face
• Neck
• Webbed spaces of the fingers
• Flexor surfaces of the wrists
• Elbows, Axillae, feet, scrotum.
• SYMPTOMS
• Itching, often severe and usually worse at night.
• Thin, irregular burrow tracks made up of vesicles
• Diagnosis is by physical examination of the skin and microscopic
examination can be done to determine the presence of mites or their eggs
Treatment
• Topical medications
- 5% permethrin cream
- 10% Crotamiton cream
- 1% Lindane lotion
- 25% benzyl benzoate lotion
- 5-10% sulfur ointment
 Onchocerciasis
• Also known as river blindness and Roble’s disease.
• A parasitic disease caused by infection by Onchocerca volvulus, a
nematode(roundworm)
• The parasite is transmitted to humans through the bite of a black fly of
the genus Simulium.
• Signs and symptoms
• Skin involvement typically consists of intense itching, swelling and
inflammation
• Skin atrophy: loss of skin elasticity, the skin resembles tissue paper,
“lizard skin” appearance
• Depigmentation
Treatment
• Infected persons are treated with two doses of Ivermectin, six months
apart, repeated every three years.
 Fungal infection(Dermatophytes)
• They are superficial ringworm type also referred to as Tinea infections.
• Three genera of dermatophyte fungi cause tinea infections
• They include:
- Trichophyton- skin, hair and nail infections
- Microsporum- skin and hair
- Epidermophyton- skin and nails
Dermatophtes only invade the stratum corneum. Inflammation is as a
result of metabolic products of the fungus or delayed hypersensitivity.
Zoophilic fungi(spread from animals to human) cause a more severe
inflammation and Anthropophilic fungi( spread from person to person)
cause less inflammation.
• Tinea Pedis (athlete’s foot)- the most common type. There are three
common clinical patterns
-soggy interdigital scaling.
- Diffuse dry scaling of the soles
- Recurrent episodes of vesication
• Tinea Corporis – affecting the body (itchy, annular patch, well defined
edge, with scaling more obvious at edges and central clearing)
• Tinea Cruris- the groin (called “Jock itch”). The upper inner thigh is
involved and lesions expand slowly to form sharply demarcated plaques
with peripheral scaling.
• Tinea Unguium (nails)- initial changes occur at the free edge of the nail
which becomes yellow and crumbly. More common in the toes than the
fingers
• Tinea capitis (scalp)- usually a disease of children. Anthropophilic
organisms cause bald and scaly areas, with minimal inflammation and
hairs broken off 3-4mm from the scalp. Zoophilic fungi cause a more
intense inflammation with postulation and lymphadenopathy(kerion)
Hair loss may be permanent
• Tinea Incognito- the usual appearance of a fungal infection masked by
mistreatment with topical steroids
• Picture
Treatment
• Local- with topical preparations eg Miconazole, Clotrimazole , for
minor skin infetions

• Systemic- for widespread and chronic skin infections

Include: Terbinafine, Itraconazole, Griseofulvin
Cutaneous Larva Migrans
• Also known as creeping eruptions, is caused by burrowing larvae of
animal hookworms.
• Parasite eggs are passed in feaces of infected animals, into the soil
where the larvae hatch out.
• Humans become infected after skin contact with contaminated soil.
• Larvae migrate beneath the skin between a few days and a few months
after initial infection.
• Clinical features include:
• Itchy papules with develop into serpiginous tunnels in the epidermis.
The lesion shifts with movement of the larvae in the skin. Hence the
name ‘creeping eruptions’
• Treatment
- Antihelminthic namely Albendazole, mebendazole
- Topical steroid to relieve the itching
Urticaria
• Also called Hives. It is a skin rash caused by an allergic reaction to
food, medications or irritants
• It is characterized by itchy weals, with or without surrounding
erythematous flares.
• A weal is a superficial skin-coloured or pale skin swelling, usually
surrouned by erythema that lasts anything from a few minutes to 24
hours
• Urticaria can co-exist with angioedema, which is a deeper swelling
within the skin or mucous mebrane
Treatment
• Hives can resolve without treatment
• Antihistamines to improve symptoms
• Other options include steroids and anti inflammatory medications
PIGMENTATION
• Vitiligo
• Albinism
 Vitiligo
• This is a skin condition in which the pigment cells of the body
(melanocytes) are destroyed in some areas of the body.
• It presents as white skin patches in any area of the body due to
depigmentation.
• It is also seen in hairs as they contain melanin.
• It is thought to be idiopathic or of autoimmune cause.
• Classified into three groups
- Local(segmental) vitiligo- occurs at one or few areas of the skin
- Generalized(Non-segmental) – affects a large part of the body
- Universalis vitiligo- lesion completely or almost completely (>80% of body
surface) covers the skin
• Picture
Treatment
• There is no cure for vitiligo
• Sunblocks can be used to prevent burning

• Complications include: Social and Psychological stress, sunburn and

skin cancer
Albinism
• A congenital disorder characterized by partial or complete absence of
melanin pigment in the skin, hair and eyes, This is due to the absence
or defect in the tyrosinase enzyme involved in the production of
melanin.
• MELANIN:
- Provides a natural protection against the harmful effects of ultraviolet
rays of the sun
- A mechanism for absorption of heat from the sun
- Important for sharpness of vision
• Hypopigmentation to no pigmentation at all, resulting in white or very
pale skin color
• Highly sensitive to sun burns
• More susceptible to skin cancer
Treatment
• No cure for albinism
• Sunscreen and UV protective clothing
CRUSTS
• Eczema
‘Eczema’, from a Greek term for ‘boiling’, a reference to the tiny vesicles
(bubbles) that are commonly seen in the acute stage of the disease

Dermatitis is inflammation of the skin and is therefore a broader term

than Eczema
Types of Eczema
• Contact Dermatitis
• Atopic Dermatitis
• Seborrheic Dermatitis
• Napkin Dermatitis
Contact Dermatitis
• This is inflammatory reaction of the skin to physical, chemical or
biological agents eg. Jewellries, detergents, alkali, solvents. It
constitutes 80% of dermatitis, Mostly industrial and usually on the
hands and forearms.
• Eruptions begin when the causative agent contacts the skin. The
acute phase includes itching, burning and erythema, followed by
edema, papules, vesicles and oozing.
• In the subacute phase, the vesicular changes are less marked and
alternate with crusting, drying, fissuring and peeling
Management
• Involves resting the affected skin and protecting it from further
damage.
• Removal of the offending irritant.
• Saline or tap water soaks, followed by a smear of corticosteroid cream
or lotion.
Atopic Dermatitis
• Means ‘without place’ in greek. It is a state in which exuberant
production of IgE occurs in response to common environmental
allergens
• Cardinal feature is itching
• Management includes:
-lubrication of dry (xerotic) skin, restoration of skin barrier function
-corticosteroids for severe inflammation and pruritus
- Antibiotics for secondary bacterial infection
Seborrheic Dermatitis
• Eczema of the hairy areas. Affects the scalp, ears, eyebrows, face, pre-
sternal area, axillae, umbilicus, groin.
• There is a characteristic greasy yellow scales. May be red scaly
exudative or dry scaly
• Overgrowth of pityrosporum yeast skin commensals plays an
important part in its development
• May affect infants but is most common in adult males.
• Treatment includes antifungals, weak steroids, antiseptics.
Napkin(diaper) Dermatitis
• Moist erythema of napkin area sparing the skin folds.
• Irritant in nature aggravated by waterproof plastic pants, feces and
urine.
• Candida superinfection is common
• The child should be free of napkins as much as possible to allow
healing.
VESICLES
• Herpes simplex
• Herpes zoster
• Chickenpox
Herpes simplex
• Herpes simplex viruses belong to the ubiquitous herpesviridae family.
• They cause contagious infections with a large reservoir in the general
population
• HSV-1 is normally associated with orofacial infections and encephalitis
• HSV-2 usually causes genital infections and can be transmitted from
infected mothers to neonates
• HSV-1 is spread by contact, usually by infected saliva and primarily
infects skin above the waist
• HSV-2 is transmitted sexually or from a maternal genital infection to a
newborn and primarily infects skin below the waist.
• HSV causes cytolytic infections and pathologic changes are due to
necrosis of infected cells together with inflammatory response.

• HSV-1 > Acute gingivostomatitis, recurrent Herpes labialis(cold sores).

Herpetic whitlow, keratoconjunctivitis, Encephalitis

• HSV-2 > Genital herpes, Neonatal herpes

Treatment and Prevention
• Acyclovir, Valacyclovir, Famciclovir
• Asymptomatic shedding is frequent in patients with genital herpes
• Transmission can be reduced by avoiding contact with potential virus
shedding lesions
Herpes Zoster
• Also known as Shingles. It is an acute viral infection of the nerve cells
and surrounding skin.
• Characterized by vesicles, can be very painful but not life-threatening.
• Caused by the varicella zoster virus that also causes chickenpox.
• Primary infection results in varicella(chickenpox)
• Recurrent infection results in Herpes zoster(shingles)
• Can be transmitted by direct contact with open sores of shingles
vesicles and can be passed to someone who has never had the
chickenpox.
Clinical presentation
• Initial prodomal stage: there is headache, fever, malaise and myalgia.
• Acute stage:
- A rash begins to develop, often causing a pain
- Itching and tingling sensation in the area of the affected nerve
- Vesicles then develop a few days after
- Vesicles break open and crust over in 7-10 days and this clears within
2-4 weeks
Management
• Antiviral medications to reduce pain and complications. Should be
started within 24hours of first symptom. Medications include:
-Acyclovir
-Valacyclovir
- Famciclovir
Chickenpox
• It is also known as varicella and it is caused by the varicella-zoster
virus
• An extremely contagious infection, usually a benign illness of
childhood characterized by exanthematous vesicular rash
• Chickenpox is an airborne disease which spreads easily through the
coughs and sneezes of an infected person. Can also be spread through
contact with the vesicles
• It may be spread from 1-2 days before the rash appears until all
lesions have crusted over.
 Clinical manifestaions
• The main symptoms of chickenpox: rash, low-grade fever, malaise
• The disease has four phases:
-Incubation period: ranges from 10-21days, usually 14-17 days. Patient is
asymptomatic during this period
- Prodromal period(pre-eruptive): symptoms include: nausea, loss of appetite,
myalgia, fever and headache. This stage lasts for 24hrs in children and 2-3 days
in adults
- Exanthem period(eruptive): rash begins as multiple erythematous papules.
After about 12-24hrs they become itchy vesicles which continue to appear in
crops for the next 2-5 days.Rash first appears on the scalp, neck, face or upper
half of the trunk and very rapidly, over hours spread to other areas of the body.
- Reconvalescence period
Prevention and treatment
• Passive immunization by specific immunoglobulin
• Active immunization by vaccine
• Anitiviral drugs
Pustules
• Impetigo
This is a superficial skin infection seen most commonly in children and
easily transmitted from person to person
Caused by the bacteria S. aureus alone or in combination with S.
pyogenes
Based on the clinical presentation, it is divided into:
- Bullous Impetigo
- Non-bullous Impetigo
• There are two ways an initial infection can occur:
 Primary impetigo: when the bacteria invades the skin through a cut,
insect bite or other injury
 Secondary impetigo: where the bacteria invades the skin because
the skin barrier has been disrupted by another infection such as
scabies or eczema.
Impetigo occurs on exposed skin, mainly the face and it is most
common during hot, humid weather, which facilitates microbial
colonization of the skin.
 Bullous Impetigo
• This is caused by staph bacteria that produce a toxin that causes a break
between the epidermis and lower levels of the skin, forming a
blister(bulla). Bullae appear in various areas of the skin, especially the
buttocks. The blisters are fragile and often break and leave red, raw skin
with ragged edges

• Non-bullous Impetigo: this is the common form caused by staph and

strep bacteria. It appears as pustules and scabs which then form yellow
or honey-coloured crusts. They often start around the nose and on the
face, but also affects the arm and legs.
 Sign and symptoms
• Pruritus is common and scratching leads to further spread of infection
through excoriation of the skin
• Weakness, fever and diarrhea are sometimes seen in bullous impetigo
• Non-bullous impetigo initially manifests as vesicles
• The lesions rapidly develop into pustules that rupture readily
• Regional lymph nodes may be enlarged

Impetigo is contagious mainly from direct contact with an infected

person. Can be transmitted through towels, toys, clothing and household
items.
Treatment
• Can resolve spontaneously without treatment.
• Mild cases can be handled by gentle cleaning, removing crusts and
applying antibiotic ointments
• Severe cases may require oral antibiotics.