Transcript: The Cinical Setting Family History: Father has eczema Social history: Unempoyed- previous cleaner and now stays at home to look after her children, Supported by her mother. Children’s father not involved Lives in Bonteheuwel Grade 10 education, left school early Claims to not know anything about eczema Images: clear images / diagrams (e.g. itch-scratch cycle) were used Diction: We took the fact that she left school early into account. We used simple, straight to the point language. Avoiding jargon . Who is our patient? Examination: General- looks well, no lymphadenopathy Face: Atopic features- allergic shiners, deni-morgans lines, salute sign, dry skin Dry /eczematous scalp, notable dry flakes in hair Limbs:Post inflammatory hyperpigmentation , lichenification in wrist,elbow and ankle creases, eczematous rash and ulceration Back: eczematous rash and excoriations with post inflammatory hyperpigmentation Ms Bennett is a 27 year old lady, RVD negative, #Asthma #atopic eczema since she was 3 months old. Previous hospitalisation in 2010 Has been in remission since 2010 Now presents with an atopic eczema flare with superimposed infection. This is her second hospital admission. Patient Leaflet Design Our patient... DERMATOLOGY PRESENTATION History Taking Augusta Kodua-Agyekum Phethego Kgatla Sarah Parker Monkgogi Thakgathi Amber Johnston Patricia Omwansa Why this info? Ms. B has an alround lack of knowledge - from what eczema is, what caused to how she can prevent it and basic pot care Very shy and timid Concern over whether the children have or will get eczema Highest level of education is grade 10 Stress youg child admitted to RXH Any Challenges? Primary presenting problem: 2 week hx of Itchy rash involving all the limbs, the back and scalp, with pain and swelling of the right lower leg No fever Was unable to get creams from the clinic, and has been stressed as well as using perfumed soap Past medical History: G2P2, 2 week old and a 1 year 4 month old RVD negative tested 1 month ago Asthma on Asthavent – last needed nebulisation >1 year ago Previous admission for eczema in 2010 Allergic to penicillin Allergic rhinitis to dustmite- uses no nasal spray/antihistamines Eczema triggers: dustmite, eggs, milk and cheese No other illnesses MBCHB V: MDN5005W Examination Patient Info Leaflet Patient Info Leaflet Format: Labels for aqueous cream container Colours: Several colours are used.
Transcript: Presented by PERSON for COMPANY Poxviral disease & cutaneous sequelae What is a Poxvirus? What is a Poxvirus? > Oval-shaped virus with double-stranded DNA genome > Found world-wide; cause disease in humans & animals > Viral infection cause cutaneous lesions, nodules and/or disseminated rash Genus Orthopoxvirus Genus Orthopoxvirus Most notable: > Variola virus (Smallpox) > Cowpox virus > Vaccinia virus (smallpox vaccine) > MonkeyPox virus MonkeyPox Virus Electron Microscopy of Monkeypox Virions MonkeyPox Virus Vaccinia Virus Color-enhanced electron Microscopy of Vaccinia Virus Vaccinia Virus Cowpox Virus Electron Microscopy of Cowpox virions Cowpox Virus Variola Virus Color enhanced electron Microscopy of Variola Virus Variola Virus Genus Parapoxvirus Genus Parapoxvirus Most notable: > Orf Virus Orf Virus Electron Microscopy of Orf Virus Orf Virus > Molluscum Contagiosum Virus Genus Molluscipoxvirus Genus Molluscipoxvirus Molluscum contagiosum Virus Electron Microscopy of Molluscum Contagiosum Virions Molluscum contagiosum Virus Smallpox Smallpox > present for thousands of years (spread via respiratory droplets or skin-skin contact) > caused deadly epidemics in humans in which humans are the only host; 3 out of every 10 cases were fatal (Variola major) > death due to hypotension and toxemia with multi-organ failure > Last outbreak in U.S. in 1949; in world, somalia in 1977 > WHO declared complete eradication in 1980 (use of vaccinia virus vaccine) > Last strains contained at the CDC & Vektor Institute in Russia (precautionary measurement against possible bioterrorism) Signs & Symptoms Signs & Symptoms > clinical manifestations: Incubation = 7-19 days (Not contagious) no s/s. Prodromal Phase = 4-5 days; Fever (> 40 deg C), Severe headache, Malaise, N/V, Body aches. erruptive phase = 14 days (Highly contagious) errythematous macules form & turn into papules on the tongue & mouth, then spread to trunk & extremties in 24hrs, While fever subsides. vesicles form then turn into fluid-filled pustules with umbilication (always in same stage of development) up to 4-6mm in diameter. fever recurs until crusting & scabs form. Macule Papule Pustule "Pox" Vesicle Crust Scar Diagnosis & Treatment Diagnosis & Treatment > Differential diagnosis: HFMD, measles, secondary syphilis, severe chicken pox, cowpox & monkeypox. > Treatment: There is no cure. IF thought present, contact health officials immediately & Quarantine infected patient w/ respiratory & contact isolation x at least 17 days. Vaccination (Vaccinia virus vaccine) within incubation period significantly decrease risk of transmission to contacts. Roosevelt Island, NY, NY Renwick smallpox hosptial mid-1800's, opened for 19 years, 7,000 patients annually disease course disease course > course: around 14 days > common complications: Blindness from corneal ulcers, encephalitis, stillbirth/spontaneous abortion/infertility, arthritis, Osteomyelitis, Pnuemonia, severe "pockmark" scarring & possible death Prevention Prevention > Vaccinia virus vaccine > Not used in general vaccination protocol today > prevents infection in 95% of those vaccinated > pricked into 5mm area of arm & is kept covered (a papule then pustule forms that will crust over & scab in 2-3 weeks) > systemic viral rxn possible; Vaccinia immune globulin (VIG) available Clinical Subtypes Clinical Subtypes 1) Ordinary-type (discussed previously, 90% of cases). 2) modified-type (commmonaly seen in previously vaccinated individuals, duration around 10 days, no fever, less cutaneous lesions). 3) flat-type (malignant) (frequently infected children, lesions coalesce together and never form pustules, intense toxemia occurs, prior vaccination protective). 4) Hemorrhagic-type (pregnant women more susceptible, shorter incubation period, worsened prodromal s/s with higher fever, petechiae & skin/mucosal hemorrhages, death in 5-6 days due to profound toxemia & multi-organ failure, prior vaccination not protective). Source: CDC’s Dr. Robinson Source: Fenner F, Henderson DA, Arita I, Ježek Z, Ladnyi ID. Smallpox and its eradication. Geneva, Switzerland: World Health Organization; 1988 (p.33). Source: Herrlich A, Mayr A, Munz E, Rodenwaldt E. (1967). Die Poken; Erreger, Epidemiologie und klinisches Bild, 2nd ed., Stuttgart, Thieme.) Cowpox Cowpox > a zoonotic infection > transmission via skin contact with viral lesions on utter or teat cups of milking machines of an infected dairy cow. Also referred to as "Catpox," transmitted by breaks in the skin by an infected cat or small rodent > Infection seen in dairy farmers (historically, seen in milk-maids) & people who own small mammals (is not transmitted human-to-human) > Last outbreak seen in 2001 in Egypt > In 1796, edward jenner performed variolization by inoculation with the cowpox virus to confer immunity against aquiring the deadly smallpox virus Signs & Symptoms Signs & Symptoms > clinical manifestation (humans): presents as solitary or multiple erythematous ("beefy red")
Transcript: HEALTH STRATEGY PLANNING Company DATE SUMMARY SUMMARY SWOT SWOT S W O T STRENGTHS STRENGTHS WEAKNESSES WEAKNESSES OPPORTUNITIES OPPORTUNITIES THREATS THREATS Diseases 1 diseases These include the following (other slides go into more detail) : -Acne -Rosacea -Hives -ringworms -Shingles -Dandruff -Onychomycosis -Insect/related diseases -psoriasis 1 Symptoms Symptoms(Docile) These common diseases are still desructive (to an extent) but will not do as much damage as the others. ~ Acne > These are red bumps that will form on your face due to too much of something, such as buildup of bacteria and oil (or, you haven't cleaned your pores). The color will tell you why you have acne. Blackheads are just what you think- acne with a black top or 'head'. these are from unclean pores. Whiteheads are almost like blackheads, but have puss instead. These are caused by your skin being infected due to too much of something in your body. DO NOT POP WHITEHEADS. Dandruff > These are white flakes over your scalp, suggesting you don't clean your hair very well. If built up, your hair will look more oily than normal. Insect bites/stings > Exactly what you think. Depending on what kind of bites you have gotten (I.E : black widow, brown recluse), you may need medical attention. more symptoms Symptoms (moderate) Rosachea > The sudden, erratic reddening on your face. Could be from a broken or dialated blood vessel, and is accompanied by red, pus filled pimples. this is an uncurable disease. Pustules > a variation of acne. These are caused by the infection of a pimple when popped. Ringworms > Highly contagious, this fungus infects the body. leaving red circles in their wakes, giving the disease its name. It can be treated with antifungal medication. Psoriasis > the formation of scaly crust along the scalp, nails, ect. Shows signs that you have a bad immune system. Even more symptoms Diseases (severe) Shingles - this disease is a strain from chicken pox. It causes painful rashes and blisters, and it occurs usually later in life. though it can be short lasting (at most, a few weeks), it's rare that any case is fatal. Hives - This rashy disease is caused by exposure to certain foods, medications, or other irritants Onychomycosis - FOCUS AREA 2 TREATMENT 2 THE PROBLEM ACNE TREATMENTS $ JAN FEB MAR #1 #2 #3 2017 Everyone knows how to get rid of acne. Just wash your face! But is your face wash really the best. Some of the best face washing products include: Cetaphil, Proactiv, Murad, Exposed, and Rodan & Fields. People can sometimes thinkthat the cheapest treatment doesn't help you, and then PLAN PLAN TIMELINE #1 #2 #3 TIMELINE FOCUS AREA 3 FOCUS AREA 3 THE PROBLEM THE PROBLEM $ JAN FEB MAR #1 #2 #3 2017 PLAN PLAN TIMELINE #1 #2 #3 TIMELINE
Transcript: Dermatology DERMATOLOGY The field of dermatology is a diverse field that pertain to the diagnosis and treatment of skin conditions. Some of the larger fields include pediatric dermatology, surgical dermatology, and cosmetic dermatology. INTRO TO DERMATOLOGY RESPONSIBILITIES & PERSONAL ABILITIES QUALITIES & ABILITIES 1 Must be able to communicate to patients in a comfortable and professional way. Must be able knowledgeable and be able to convey that information to others in simple terms Teamwork and cooperative skills. 2 3 REQUIREMENTS & POST EDUCATION Educational Requirements To become a dermatologist the basic requirements are: -Completing a bachelors degree at a college that offers a pre-med classes. (4) -Continuing to medical school and recieveing a degree in your area of study. (4) -One or two years at a practice as an internship -At least three years in residency. - Any continued education after this is considered fellowship. Colleges Clemson University Anderson University UNC Chapel Hill USC All of these colleges offer pre-med courses in the form of bachelor degrees MUSC VCOM-Virginia Both of these colleges offer medical doctorate degrees. To practice dermatology, one must complete a license test in the state they intend to practice in. The tests may vary from state to state. In order to practice, you must be certified uninterestedly in at least one state, have a medical degree, and pass several exams periodically to keep their license. Certifications & Licenses Employment There are several places of employment in the SC area: -Carolina dermatology -Dermatology Associates -South Carolina Skin Cancer Center There is also the options of building your own practice or going into a co-op with another doctor. JOB OUTLOOK & ADVANCEMENT SALARY Salary The starting salary of a dermatologist working full-time is in the range of 220,000-300,000$. The median salary range of dermatologist including specialist is estimated to be close to 450,000$ OUTLOOK Job Outlook and Advancement The Job outlook for dermatology is expected to have an increase of demand of about 14% in the next decade. Advancement in the dermatology field is seen in new technologies and programs that can help identify skin conditions more accurately and consistently. EXAMPLE Example CAROLINA DERMATOLOGY 920 Woodruff Road, Greenville, SC, 29607 SOURCES TIMELINE Bloom, L. (2018, August 07). How to Become a Dermatologist: Salary, Job Description and Requirements. Retrieved from https://work.chron.com/salary-beginner-dermatologist-2591.html How to Become a Dermatologist. (2014). Retrieved from http://doctorly.org/how-to-become-a-dermatologist/ (n.d.). Retrieved from https://learn.org/articles/Dermatologist_Career_and_Salary_FAQs.html
Transcript: RASH In the future, everything is illegal alcohol Violent Sports french fries We have taken procautions to prevent these kinds of accidents from ever happening again Because of these procautions, we have prevented needless injuries like these. If we all just take a few simple steps to avoid situations that can cause injury and harm, we can keep eachother safe. For more information and tips to keep your family safe, visit us at USSA.com/bsafe After all it is beter to be safe than be in jail! Protective masks and goggles In the past thousands of people had been injured in needless accidents Helmets Protective Gloves And other padding The USA is Now called the USSA (United Safer States of America) Knee Gaurds
Transcript: Excisional biopsy Full thickness punch biopsy if excisional biopsy not possible several locations if large and ill-defined scallop biopsy -- get underneath lesion. What is it? Who gets it? How do I recognize it? What can be done about it? Psoriasis clinical features: Not to be confused with: white>hispanic>asian>black increasing incidence over time increasing risk with ^ number of moles and size of moles (>5 mm) FHx, dysplastic nevus syndrome, immunosuppression, UV exposure, equatorial, fair skin types, high SES. Dysplastic, Clark's nevi <10% of caucasians sporadic or familial single or multiple cutaneous marker for ^ risk melanoma atypical mole syndrome -- management controversial. Biopsy it! tinea excema lupus mycosis fungoides pemphigus follacious (ai blistering condition) Complex inflammatory disorder of the skin. Immune system is disordered and the result is thickening and reddening of the skin. associated with decreased QOL and social stigma also associated with arthritis cvd, & metabolic syndrome, possibly lymphoma INFORMED for PCPs www.skinsigh.com Atypical moles ABCDE Early recognition Dermatology Presentation: One deadly, one common, one rare www.psoriasis.org National Psoriasis Foundation HCV Drug induced: thiazides, chloroquine, quinidine guttate inverse pustular (dangerous -- fever, hypocalcemia, respiratory distress, hepatitis and CHF erythrodermic (also dangerous -- tachycardia, fluid and lyte imbalances, fevers. Hospitalization). asymmetry border irregularity color variegation (flag sign) diameter > 6mm evolution pruritis, pain, bleeding, ulceration 5 year survivival: all cases 92% localized 98% LNs 62% Metastatic 16% Mimickers More common in women, peak incidence in their 60's Treatments age 20-30, then second peak 50s-60s. 2/3 of patients have a mild disease, manageable with topical medications; often relapsing and remitting course staged by: Depth (thickness) SLNB What is it? Who gets it? How do I recognize it? What can be done about it? Risk varies by ethnicity and individual risk factors 4 P's pruritic polygonal purple papules +Wickham's striae + wrists, ankles, buccal mucosa, genitals+ sharp demarcation silvery scales glossy, homogenous, erythematous base Auspitz sign Koebner phenomenon Lichen Planus Treatment: self limiting 1-2 years topical steroids systemic steroids topical retinoids systemic retinoid (acitretin) immunomodulators systemic (cyclosporine) topical calcineurin inhibitors (off label) like Tacrolimus, Pimecrolimus. SK solar lentigo vascular tumors (hemangiomas) dermatofibroma pigmented BCC Triggers lentigo maligna melanoma superficial spreading melanoma nodular melanoma acral lentiginous melanoma trauma drugs - beta blockers, lithium, NSAIDs, steroid withdrawal, pregnancy and OCs. alcohol and smoking infection AIDS sunlight topical Vit D (calcipotriene), steroids, coal tar, retinoids (tazarotene) UVB, PUVA cyclosporine methotrexate oral retinoids biologics Four main clinical varieties Melanoma
Transcript: DERMATOLOGY What Is A Dermatologist? What Does A Dermatologist Do? Becoming A Dermatologist... A Dermatologist is a doctor who specializes in treating the: Skin Hair Nails and the mucous membranes which are the linings inside the mouth nose and eyelids. From start to finish the process of becoming a dermatologist can take up to 12 years, this allows general doctor training before moving into the dermatology specialised area. Cosmetic Dermatology - deals with skin flaws and ageing problems Medical Dermatology - deals with things such as skin cancer, lupus and cases of rosacea. Surgical Dermatology - deals with skin tissue that cannot be treated with medicines. 3 Types of Dermatology A Dermatologist diagnoses and treats over 3,00o different diseases, these can include eczema, psoriasis, nail infections and even skin cancer. They can also help patients diminish wrinkles, age spots and acne scars.
Transcript: "Doc, I've got this weird rash" Intro "Yeah that looks like some kind of rash" Dermatologist (noun) [dur-muh-tol-uh-jist] 1. From Greek, meaning "fake doctor" Rash: bad chief complaint, or the worst chief complaint? 1. Rash rules 2. Derm terms 3. Cases (in yo faces?) 4. Questions (rosh) 5. Questions (you) Overview Overview Caveats 1. It turns out that there is an entire specialty devoted to this 2. I cannot teach an entire specialty in 45 minutes, even this one 3. Most of this presentation will be talking about adult rashes 4. I'm going to assume you know what anaphylaxis looks like and what to do about it. Caveats Ross's Rash Rules (Recall that rules require some reservation) Ross's Rash Rules (Recall that rules require some reservation) 1. At least 95% of the rashes we see are not dangerous 2. Mucous membranes = bad 3. Rapidly progressive = bad 4. Systemic symptoms = bad 5. Skin sloughing off = bad 6. Palms/soles = bad 7. It's always lupus 8. It's never lupus 9. Come up with a rash script Questions to ask those with rashes Questions to ask those with rashes Meds (including recent abx/OTC meds) Travel Other new exposures (shampoo, detergent, etc) Hx of similar rashes Associated symptoms Exposure to others with similar rash Bugs/ticks Derm Terms (basic) Derm Terms (basic) Macule (patch) Papule (nodule) Vesicle (bulla) and pustules Plaque Don't call derm and call something a maculopapular rash. They will hate you. Defined as change in color, does not have texture. Macule <1 cm, patch >1 cm. Macule and Patch Macule and Patch Papule - raised, on surface of skin, usually <1 cm Nodule - raised, often under the skin, "better felt than seen", usually >1 cm Papule and Nodule Papule and Nodule Vesicle: raised, fluid filled structure <0.5 cm Bulla: raised, fluid filled structure >0.5 cm Pustule: raised, fluid filled structure filled with pus, usually <1 cm Vesicle, Bulla, Pustule Vesicle, Bulla, Pustule Well-circumscribed, raised, palpable lesion Plaque Plaque Find a way to organize "dangerous rashes" in your brain. Some suggestions: Drug reactions vs infectious vs autoimmune Appearance of rash (whole body erythema, bullae, urticaria, etc) Cases Cases Case 1 Case 1 32 y/o male presents to the ED. "I just got this weird rash". Being an astute clinician, you ask about new medications, and find out that he has bipolar disorder and was just started on a new medication. You see the following rash. What is your presumptive diagnosis, what do you think the offending agent was, and what do you want to do? Spectrum of disease - EM minor (who cares), EM major (care a little bit), SJS (ruh roh), TEN (if you send this home you messed up). Supportive care - fluids, electrolytes, burn center if SJS/TEN, stop offending med. Unclear if steroids/IVIG/cyclosporine might be useful. For EM major with mucosal involvement, most sources say give steroids. Causative agents include: phenytoin, carbamazepine, lamotrigine, phenobarb, sulfa drugs, allopurinol, NSAIDs Dx/Tx? Causative agents? Dx/Tx? Causative agents? Spectrum Spectrum Name this sign Name this sign You are hard at work in the pediatric ED having seen your 12th iteration of either "fever, cough" or "fever, ear pain" when suddenly "fever, rash" pops up on the board! You see an unhappy looking kiddo with the following rash. Case 2 Case 2 Staphylococcal scalded skin syndrome - and think about toxic shock syndrome. Caused by staph aureus (surprise!). Often prodrome of fever, skin pain, irritability though can be just sudden erythema. +Nikolsky sign. Treat with abx with MRSA coverage. If child looks well, is older than 1 year, takes PO and the case is mild, can try outpatient treatment. Otherwise admit for IV abx. Warn parents that most of skin will desquamate, but should grow back within 7-14 days. Dx/Tx? Dx/Tx? Case 3 (real!) Case 3 (real!) 48 y/o female with history of metastatic melanoma presents with fever, hypotension and the below rash after starting dasatinib 3 weeks prior. What is your workup and management? -WBC 12.6 with atypical lymphocytes -8% eosinophils -AST/ALT 157/138 -Cr 1.2 (baseline 0.7) Workup Reveals... Workup Reveals... DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) -Typically 2-6 weeks after causative drug (allopurinol, seizure drugs, some cancer drugs) -Suspect if: morbilliform rash, hx of drug exposure in correct timeline, fever, facial edema, enlarged lymph nodes -As discussed, check labs including CBC, BMP, LFTs, consider checking trop (myocarditis). Pneumonitis is also possible. -Tx: STOP THE DRUG. If severe, can try steroids ~1-2 mg/kg of prednisone/day until improving, then taper. Dx/Tx? Dx/Tx? A 48 year old woman with mild rheumatoid arthritis presents with blisters "that have been there for a couple weeks, but got way worse the last 2 days. And they hurt really bad". On exam, you find the lesions below, near her lips. Case 4 Case 4 Dx/Tx? Dx/Tx? Highlights: -mucosa often first in pemphigus. -flaccid bullae, Nikolsky + -biopsy of intact
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