Review in one month for relief of symptoms - other than cancers
ACNE
● Expansion and blockage of follicle and inflammation
● Aggravating factors for flares: PCOS, drugs (eg, steroids, hormones,
anticonvulsants), occlusive cosmetics, humidity, high dairy/glycaemic foods
● Symptoms: face (mainly)/neck/chest/back, open and closed uninflamed comedones
(blackheads and whiteheads), inflamed papules and pastures
● Mx:
○ Mild - total lesion count <30 → topical anti acne agents, ie, benzoyl
peroxide +/- tretinoin or adapalene; low dose oral contraceptive
○ Moderate - total lesion count 30-125 → as for mild + tetracycline,
eg, doxycycline 50-100mg daily for 6 months; spironolactone
○ Severe - total lesion count >125 → refer to dermatologist for oral
isotretinoin/roaccutane
ATOPIC DERMATITIS/ECZEMA
● Causes: genetic/environmental factors, defect in skin barrier makes skin more
susceptible to irritants
● Triggers: soaps/additives in creams, weather changes, temperature, infections, foods
(eg, citrus, strawberries, tomatoes), stress, environment
● Symptoms:
○ Acute flares: red, inflamed, blistered, weepy; between flares skin appear
normal/lichenified
, ○ Infants: wide distribution including cheeks, nappy area usually spared
○ toddlers/preschoolers: starts in extensor surfaces, may affect genitals; pattern
change to involve flexor surfaces and less extensor with age
○ School aged: flexural involving knees/elbow creases, eye lids, earlobes, neck,
scalp; most improve in teens
○ Adults: varies; poorly controlled leads to lichenification
● Mx:
○ Avoid irritants, soap substitutes, oatmeal bath, emollients
○ Treat infections - bacterial treated with mupirocin/oral antibiotics
○ Topical steroids, topical calcineurin inhibitors, antihistamines, phototherapy
○ longstanding/severe treated with immunosuppressive agent, eg, ciclosporin,
axathioprine, methotrexate
⇒ SKIN CANCERS
BCC
● BCC - 70%; grow very slowly over months, rarely spread, untreated can grow deeper
and damage nearby structures
○ Nodular: papule/nodule, translucent/pearly, skin coloured/reddish, smooth
surface with telangiectasia, well defined, firm
○ Ulcerating: crust, rolled border/rodent ulcer, translucent, pearly, smooth,
telangiectasia, firm
○ Sclerosing: small patch of morphea/superficial scar, ill defined, skin coloured,
whitish
○ Superficial: thin plaques, pink/red, fine threadlike border, telangiectasia,
scaling
○ Pigmented: brown/black/blue, smooth glistening surface, hard, firm, difficult to
distinguish from nodular melanoma
● Risk factors: fair skin, Fx, UV exposure, smoking, HPV infections,
immunosuppressed, skin conditions (eg, lichen sclerosis, SLE), genetic conditions
(eg, albinism)
● Dx: partial biopsy - non-melanoma lesions; complete excision biopsy - melanoma
lesions with appropriate margins
● Mx: excision, cryotherapy, topical therapies (eg, fluorouracil cream)
● Broader GP Mx: management of stitches, regular skin checks
○ sun protection, regular skin checks every 3-6 months
○ Return immediately if lesions change/suspicious lesions arise
SCC
● 30%; grow quickly over weeks/months, can metastasise if untreated
● plaque/nodule with varying degrees of keratinisation; lump, nodule, ulcer, changing
shape/size/colour, itch, bleed, lymph node involvement, ABCDEs pigmented lesions
● Risk factors: fair skin, Fx, UV exposure, smoking, HPV infections,
immunosuppressed, skin conditions (eg, lichen sclerosis, SLE), genetic conditions
(eg, albinism)
● Mx: excision with appropriate margins
● Broader GP Mx: management of stitches, sun protection
○ One or more SCCs checked every 6 months at first, but if develop more
interval diminishes
○ Return immediately if lesions change/suspicious lesions arise
ACNE
● Expansion and blockage of follicle and inflammation
● Aggravating factors for flares: PCOS, drugs (eg, steroids, hormones,
anticonvulsants), occlusive cosmetics, humidity, high dairy/glycaemic foods
● Symptoms: face (mainly)/neck/chest/back, open and closed uninflamed comedones
(blackheads and whiteheads), inflamed papules and pastures
● Mx:
○ Mild - total lesion count <30 → topical anti acne agents, ie, benzoyl
peroxide +/- tretinoin or adapalene; low dose oral contraceptive
○ Moderate - total lesion count 30-125 → as for mild + tetracycline,
eg, doxycycline 50-100mg daily for 6 months; spironolactone
○ Severe - total lesion count >125 → refer to dermatologist for oral
isotretinoin/roaccutane
ATOPIC DERMATITIS/ECZEMA
● Causes: genetic/environmental factors, defect in skin barrier makes skin more
susceptible to irritants
● Triggers: soaps/additives in creams, weather changes, temperature, infections, foods
(eg, citrus, strawberries, tomatoes), stress, environment
● Symptoms:
○ Acute flares: red, inflamed, blistered, weepy; between flares skin appear
normal/lichenified
, ○ Infants: wide distribution including cheeks, nappy area usually spared
○ toddlers/preschoolers: starts in extensor surfaces, may affect genitals; pattern
change to involve flexor surfaces and less extensor with age
○ School aged: flexural involving knees/elbow creases, eye lids, earlobes, neck,
scalp; most improve in teens
○ Adults: varies; poorly controlled leads to lichenification
● Mx:
○ Avoid irritants, soap substitutes, oatmeal bath, emollients
○ Treat infections - bacterial treated with mupirocin/oral antibiotics
○ Topical steroids, topical calcineurin inhibitors, antihistamines, phototherapy
○ longstanding/severe treated with immunosuppressive agent, eg, ciclosporin,
axathioprine, methotrexate
⇒ SKIN CANCERS
BCC
● BCC - 70%; grow very slowly over months, rarely spread, untreated can grow deeper
and damage nearby structures
○ Nodular: papule/nodule, translucent/pearly, skin coloured/reddish, smooth
surface with telangiectasia, well defined, firm
○ Ulcerating: crust, rolled border/rodent ulcer, translucent, pearly, smooth,
telangiectasia, firm
○ Sclerosing: small patch of morphea/superficial scar, ill defined, skin coloured,
whitish
○ Superficial: thin plaques, pink/red, fine threadlike border, telangiectasia,
scaling
○ Pigmented: brown/black/blue, smooth glistening surface, hard, firm, difficult to
distinguish from nodular melanoma
● Risk factors: fair skin, Fx, UV exposure, smoking, HPV infections,
immunosuppressed, skin conditions (eg, lichen sclerosis, SLE), genetic conditions
(eg, albinism)
● Dx: partial biopsy - non-melanoma lesions; complete excision biopsy - melanoma
lesions with appropriate margins
● Mx: excision, cryotherapy, topical therapies (eg, fluorouracil cream)
● Broader GP Mx: management of stitches, regular skin checks
○ sun protection, regular skin checks every 3-6 months
○ Return immediately if lesions change/suspicious lesions arise
SCC
● 30%; grow quickly over weeks/months, can metastasise if untreated
● plaque/nodule with varying degrees of keratinisation; lump, nodule, ulcer, changing
shape/size/colour, itch, bleed, lymph node involvement, ABCDEs pigmented lesions
● Risk factors: fair skin, Fx, UV exposure, smoking, HPV infections,
immunosuppressed, skin conditions (eg, lichen sclerosis, SLE), genetic conditions
(eg, albinism)
● Mx: excision with appropriate margins
● Broader GP Mx: management of stitches, sun protection
○ One or more SCCs checked every 6 months at first, but if develop more
interval diminishes
○ Return immediately if lesions change/suspicious lesions arise
