SKIN RASH

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COMMONLY ENCOUNTERED SKIN PROBLEMS, CAUSES FOR ITCH

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SKIN RASH:

SKIN RASH DR ANGELO SMITH M.D WHPL

Describe itch:

Describe itch “local discomfort or irritation of the skin, prompting the sufferer to scratch or rub the affected area. It is the main symptom of skin disease” “a peculiar tingling or uneasy irritation of the skin that causes a desire to scratch the affected area”

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“It feels as though every nerve ending in my body is attacking me intensely at my ankles, feet, lower legs, neck, under the breasts (even the nipples tingle). It's absolutely horrendous! My hands grow red as a beet and the itching nearly takes the skin off my hands as I scratch.” “ It’s like someone tickling you under the skin”

Pathophysiology:

Pathophysiology Debate continues over whether there are specific nerve endings for itch Possibly more than one mechanism

Pathophysiology of itch:

Pathophysiology of itch Free nerve endings fibres most concentrated in wrists and ankles Unmyelinated C fibres to dorsal horn in spinal cord Scratching is a spinal reflex response ascends to cerebral cortex via spinothalamic tract Skin inflammation Psychological concerns Chemical mediators Substance P Opioid and non-opioid peptides Somatostatin Neurokinin A Histamine Serotonin Prostaglandins External mediators Environmental heat or dryness

Approach to diagnosis of itching:

Approach to diagnosis of itching History including onset, duration, pattern, effect on sleep, previous skin disease, contacts, other medical problems, drugs, response to treatment so far. Skin examination features of rash, post-inflammatory changes, signs of scratching General examination

Signs of itching:

Signs of itching distress excoriation lichenification shiny nails weals nodules

Factors affecting presentation of itchy condition:

Factors affecting presentation of itchy condition age self-control / social setting / distractions other medical conditions / ability to scratch site of itch specific skin condition duration

Causes of itch:

Causes of itch skin disorders systemic disorders psychogenic habit / itch-scratch cycle

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations : scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

Common itchy skin disorders in the young:

Common itchy skin disorders in the young infestations: scabies, lice, threadworms eczemas urticaria psoriasis (sometimes) insect bites – papular urticaria pityriasis rosea viral exanthems

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Slapped face syndrome

Common itchy skin disorders in mature adults:

Common itchy skin disorders in mature adults infestations: scabies eczemas / nodular prurigo/ xerosis urticaria psoriasis (sometimes) lichen planus bullous pemphigoid polymorphic light eruption

Common itchy skin disorders in adults:

Common itchy skin disorders in adults infestations: scabies eczemas / nodular prurigo/ xerosis urticaria psoriasis (sometimes) lichen planus bullous pemphigoid polymorphic light eruption

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sitesearch:  exact match:  © 2002 by DermIS - Dermatology Information System X O X O X O X ___________________________________________________

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                                                                                                                                                                                                    © Copyright protected - Do not copy without the editors' written permission. localization lesion description additional description upper leg paleness     upper leg wheal pale red polycyclic     purpura    

Common itchy skin disorders in adults:

Common itchy skin disorders in adults infestations: scabies Eczemas / xerosis urticaria psoriasis (sometimes) lichen planus bullous pemphigoid polymorphic light eruption

Common itchy skin disorders in adults:

Common itchy skin disorders in adults infestations: scabies eczemas /nodular prurigo/ xerosis urticaria psoriasis (sometimes) lichen planus bullous pemphigoid polymorphic light eruption

Common itchy skin disorders in adults:

Common itchy skin disorders in adults infestations: scabies eczemas/ nodular prurigo/ xerosis urticaria psoriasis (sometimes) lichen planus bullous pemphigoid polymorphic light eruption

Common itchy skin disorders in adults:

Common itchy skin disorders in adults Eczemas / xerosis urticaria psoriasis (sometimes) infestations: scabies lichen planus bullous pemphigoid polymorphic light eruption

Localised itch:

Localised itch Anogenital/ pruritus ani: Threadworms, lichen sclerosis, lice, contact dermatitis Hands: eczemas, scabies, contact dermatitis Flexures: atopic/ seborrhoeic eczema, scabies Scalp: lice, seborrhoeic dermatitis, psoriasis Any area: discoid eczema, lichen simplex chronicus, contact dermatitis

Systemic causes of itch:

Systemic causes of itch liver disease renal failure iron deficiency metabolic: protein, zinc, calcium, vitamin deficiencies thyroid disease

Systemic causes of itch:

Systemic causes of itch diabetes malignancies: lymphoma, PRV, leukaemias, myeloma pregnancy neurological drugs

Psychogenic itch:

Psychogenic itch epidemic forms - hysteria delusional parasitosis habit - itch/scratch cycle

Itchy skin – Rating scale:

Itchy skin – Rating scale

Management of itching:

Management of itching Treat the cause Treat the itch

Management of itching:

Management of itching keep looking for a cause avoid aggravating factors temperature, humidity, bedding, clothing reduce damage from scratching clothing, bandaging, cut nails

Management of itching:

Management of itching topical agents systemic agents psychological interventions

Topical agents:

Topical agents emollients antihistamines - doxepin ( Xepin ) unknown mechanism - crotamiton ( Eurax ) calamine counter-irritant - capsaicin, menthol local anaesthetics paste bandages

Systemic agents:

Systemic agents Opiod antagonists Ondansetron Rifampicin Cholestyramine Tricyclic antidepressants Thalidomide Phototherapy

Psychological and alternative interventions:

Psychological and alternative interventions Biofeedback Behaviour therapy Relaxation techniques Acupuncture Hypnotherapy Homeopathy Self-help groups

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