Professional Documents
Culture Documents
INFECTIONS
INFLAMMATORY DISORDERS
TUMOURS
OTHERS
INFECTIONS
• Molluscum contagiosum
• Tinea faciei
• Lupus vulgaris
• Demodicidosis
INFLAMMATORY DISORDERS
• Acne
• Rosacea
• Perioral dermatitis
• Lupus miliaris disseminatus faciei
• FACE
• Sarcoidosis
• Follicular mucinosis
• Pseudofolliculitis barbae
TUMOURS
BENIGN EPIDERMAL TUMORS
AND CYSTS:
DPN
Seborrhoeic keratosis
Keratoacanthoma
Milia
Tumors cont…
PREMALIGNANT
EPITHELIAL LESIONS
Actinic keratosis
Cutaneous horn
MALIGNANT
• Colloid milia
• Angiofibroma
INFECTIONS
MOLLUSCUM
CONTAGIOSUM
• Pox virus family
• Molluscum bodies
Course & treatment :
Spontaneous clearance
• Curettage
• Cryotherapy
• Electrosurgery
• Phenol
• cantharidin
• tricholoroacetic acid
• pot.hydroxide solution
• topical salicylic acid preparations
tretinoin
• imiquimod cream
• cidofovir
LUPUS VULGARIS
• Chronic progressive post primary,
paucibacillary form of cutaneous tuberculosis
• Moderate or high degree of immunity
• Underlying focus- bone, joint or lymph node
• Haematogenous or lymphatic spread
• Differential diagnosis :
Rosacea
leprosy nodules: firmer
Nodules of sarcoidosis :
resemble grains of sand
DEMODICIDOSIS
• Demodex folliculorum - follicle mite
• Areas of high sebum production
• Head down position in the follicle, 2-6 mites, motile
• Can produce papular and papulopustular lesions in
immunosuppressed individuals
• Pathogenic role: pityriasis folliculorum, rosacea, perioral
dermatitis, blepharitis
• Treatment : topical acaricides
TINEA FACIEI
• Ringworm of glabrous skin of face
• Trichophyton mentagrophytes, T.rubrum
• Direct inoculation or secondary spread from
other sites
• Itching, burning & exacerbation with sun
exposure
• Erythema +, Scaling less prominent
• Simple papular lesions or flat patches of
erythema
• D/D : PMLE and DLE
• Treatment : antifungals
TINEA BARBAE
• A disease of adult male
• Ringworm of beard and moustache areas of
face
• Invasion of coarse hairs
• Commonly farm workers
• Trichophyton verrucosum,
T.mentagrophytes
• C/F: highly inflammatory pustular
folliculitis
Hairs surrounded by red inflammatory
papules or pustules
Loose hairs in affected areas
• Treatment : antifungals
ACNE
• A chronic inflammatory disease of pilosebaceous units
• Usually starts in adolescence
• Seborrhoea , open & closed comedones, erythematous
papules & pustules, nodules, pseudocysts, scarring
• Pathogenesis : 4 factors
• 99% - lesions on face
• Early lesions – comedones
• Grading of acne
• Acne variants – infantile, occupational, mechanical,
tropical, acne excoriee, acne conglobata, acne fulminans
fulminans.
Treatment :
Differential diagnosis :
rosacea, perioral dermatitis,
gram negative folliculitis
ROSACEA
• A vascular disorder affecting central face
• Treatment
– Discontinue topical steroids
– Avoid potential contact allergens
– Oral tetracyclines for 4 weeks
– Topical tetracycline, metronidazole, erythromycin
– Pimecrolimus 1% cream
ACNE AGMINATA
• Lupus miliaris disseminatus faciei – historical
• Acnitis or FIGURE
•If shaven too long – the hair may curve backwards after
emerging from the follicle to penetrate the adjacent skin
•If cut very short – it retracts into the follicle; may directly
penetrate the follicle wall
• Steroid-antibiotic combination
creams and emollients
• Laser
TUMOURS
Benign epidermal tumors and
cysts
• DPN
• Seborrhoeic keratosis
• Milia
• Dermatosis papulosa nigra
• Treatment : electrosurgery
SEBORRHOEIC
KERATOSIS
• Benign tumor of epidermal keratinocytes
• Sign of Leser-Trelat
• Histopathological types : clonal, hyperkeratotic,
acanthotic, irritated, reticulate, melanoacanthoma
• Spontaneous clearance
Actinic keratosis
Cutaneous horn
MALIGNANT
– Surgical excision
– Non-surgical approaches:
curettage and cautery,
cryotherapy,
laser, topical imiquimod,
topical 5FU, PDT,
systemic retinoids
Tumors of skin appendages
Eccrine gland tumors : syringoma, eccrine hidrocystoma
• Treatment :
electrosurgery, cryotherapy, dermabrasion,
laser resurfacing
ECCRINE HIDROCYSTOMA
• Tumour by mature deformed eccrine sweat units; secretions dilate
the ducts
• Rare; middle aged women; exposure to heat
• Confined to cheeks and eyelids
• Cystic, blue, increase in size on exposure to heat and flattens with
exposure to cold
• Multiple, pigmented lesions on face
• Pathology : uni or multilocular dermal cystic lesion lined by 2 layers
of cells
• Inner layer- columnar , outer layer- myoepithelial cells
• Treatment : electrodessication, CO2 laser, pulse dye laser, excision
SYRINGOCYSTADENOMA
PAPILLIFERUM
• Exuberant proliferating lesion with apocrine differentiation
• Birth or childhood
• C/F : Multiple warty papules, translucent and pigmented
• Majority on face and scalp
• Pathology
– Papillomatosis with invaginations
– Cystic structures –
apocrine pattern
– Dermis – plasma cells
– Sometimes sebaceous, eccrine,
follicular differentiation
• Treatment – surgical excision
SEBACEOUS TUMOURS
• Sebaceous adenomas and
sebaceomas
• Rare; elderly
Treatment : excision
Soft tissue tumors
? Symptomatic
Triggering factors
Photosensitivity
Past history
EXAMINATION…
Morphology of predominant lesion
Number of lesions, symmetry
Size, colour and surface
? Flat topped ? Translucent
Umbilication? Erythema ? Telangiectasia
Annular lesions
Diascopy
Other types of lesions
? Scarring ? Ulceration
Distribution over face
Nasolabial fold, perioral & periocular regions
Involvement of other areas
Other systems
Investigations
GOECKERMAN REGIMEN
• Applied over the lesions for period of 24hrs
2-5% CRUDE
COAL TAR
• Excess wiped off with mineral oil
• Exposed to suberythmogenic
UV-B dose(1/3 to ½ of MED)