1. PLE Common, photosensitivity eruption Adult females 20- 40 yrs, 10% women holidaying in the med! Rash takes many forms but tends to be the same for an individual crops of 2-5 mm pink or red raised spots occurring on the arms. Also chest and lower legs, but the face is usually spared. Burning/itch May be blistered/dry or e.multiforme like May be confined to ears

2. Settles with sun avoidance, but recurs Can deteriorate if not allowed to settle – extensive hardening as the summer progresses and more sun can be tolerated some very sensitive individuals even develop PMLE in the winter immune reaction to a compound in the skin which is altered by exposure to ultraviolet radiation short wavelength UVB but also longer wavelength UVA Occurs through glass, sunblockers may be ineffective

3. Prevention Cover all affected areas Choose UPF 40+ clothing Broad Spectrum Sun Protection Factor 30+ semi-opaque sunscreen Stay in the shade Treatment Short course of oral steroids e.g. to cover a summer holiday. Polypodium leucotomos extract (PLE)(Heliocare™) Beta carotene. Hydroxychloroquine UVA or PUVA

4. PLE

6. Juvenile Spring Eruption

7. Localised from of PLE Sun induced, exposed areas esp skin of ears Occurs 8-24 hrs after exposure lasting some 2 wks Affects young males in spring (!) Itchy red lumps forming blisters and crusts Resolves after several weeks Steroids/emollients

8. Solar elastosis

9. Melasma

10. Blotchy pigmentation due to overproduction of melanin Pregnancy – will resolve with time Drugs OCP Sun Sun blockers Stop offending drugs Azalaic acid may prevent new pigment Salicylic acid creams Await resolution

13. Erosive Pustular Dermatosis Rare disorder, but do see it! Unknown aetiology Clinical diagnosis Sterile crusting erosions and pustules Seen in atrophic skin sec to actinic or other damage incl cryotherapy Yellow/brown crusts, erosions, pustules, purulent leakage and lakes of pus. Oedema, erythema, lymphadenopathy absent

14. Erosive Pustular Dermatosis

16. Treatment Remove crust with oil Treat with potent/ultrapotent topical steroid ie dermovate Review at 3 wks Investigations - nil

17. What lesions are demonstrated? What is the condition? Quizz: Max 20 Closed comedones Acne

18. 1 – what lesions are demonstrated? 2 – name the condition Pustules Acne

19. 1 – what lesion is demonstrated? 2 – can it occur alone? Open comedone Yes Giant/senile comedone

20. 1 - Would you refer this patient? 2 - What treatment would be considered? Yes Roaccutane

21. 1 – What is the diagnosis? 2 – What are the two diagnostic clues? Perioral dermatitis Perioral Vermillion area spared

22. 1 – Give three diagnostic features 2 – and the diagnosis Nasolabial sparing Erythema Telangiectasiae Pustules Papules Rosacea

23. 1 – Give a name to the complication affecting his nose? 2 – Name two ocular manifestations Rhinophyma Blepharitis Keratitis

24. 1 - Diagnosis please? 2 – What microorganism is implicated? Seborrhoeic eczema Pityrosporum ovale

25. 1 – List two classical features of this process 2 – Give the diagnosis Scarring Alopecia CDLE

26. 1 – Name the process? 2 – Give two precipitants? Melasma Pregnancy Drugs

27. Diagnosis? Lick eczema

28. ?Delayed hypersensitivity reaction to oil ?PLE acquired during a recent beach holiday in Libya Or a bad case of photoshop! http://youtu.be/JlmEc8rd_Nw

29. Thankyou!

31. Bacterial infections of skin Impetigo, cellulitis/erysipelas Folliculitis Furuncle, carbuncle, abscess Cutaneous Leishmaniasis Leprosy TB (Lupus vulgaris) Anthrax

32. Cellulitis

33. Staphylococcal Folliculitis

35. Erysipelas

36. P

37. Impetigo superficial skin infection of the epidermis characterized by translucent (“honey”) crusts caused by S. aureus and strep. pyogenes (GABHS) Flucloxacillin Bactroban topical

42. Impetigo Two variations of impetigo Bullous impetigo is more often caused by S. aureus Ecthyma has a ulcerated “punched-out” base

44. Ecythma Ecthyma begins as a vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying crust. The crust of ecthyma lesions is gray-yellow and is thicker and harder than the crust of impetigo. A shallow, punched-out ulceration is apparent when adherent crust is removed. The deep dermal ulcer has a raised and indurated surrounding margin. Ecthyma lesions can remain fixed in size (sometimes resolving without treatment) or can progressively enlarge to 0.5-3 cm in diameter. Ecthyma heals slowly and commonly produces a scar. Regional lymphadenopathy is common, even with solitary lesions

46. Cutaneous Leishmaniasis

48. TB (Lupus vulgaris)

49. Viral HSV1 Herpes Varicella/Zoster Molluscum contagiosum Exanthems

51. Eczema Atopic Eczema Contact Dermatitis Seborrheic Eczema