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123. Conjunctivitis: Bacterial, Viral and Allergic

, thyroid disorder Drug-induced: anticholinergics, beta-blockers, oral contraceptives, ophthalmic products Adverse effect of an ophthalmic product Blepharitis – red eye associated with inflammation of eyelids, crusted eyelashes, scant watery discharge; slow onset, chronic condition, may be associated with rosacea Infectious keratitis – inflammation of the cornea caused by bacteria, viruses or fungi, can progress to corneal ulcers; may be rapid onset, loss of visual acuity, photophobia, severe foreign (...) – glaucoma Hyper-purulent discharge (copious amounts of thick yellow-green pus) with very rapid onset – gonococcal conjunctivitis Visible corneal haze or opacities – keratitis, iritis, glaucoma Focal rather than diffuse redness Contact lens wearer – higher risk of infection, corneal ulceration 1) Non-pharmacologic Avoid contact lens use until symptoms have resolved Discard any eye drop bottles used during infection No-tears baby shampoo (weak solution with warm water) can be used to cleanse crusts from

2018 medSask

124. Acne - Guidelines for Prescribing Topical Treatment

Occurs near hair-line cosmetic X XX XX X Occurs where cosmetics used occupational XX X X Excoriated X X Crusts, scar, erosions, hyperpigmentation Mechanical XX XX X occurs when sinus tracts (channels) form between acne lesions resulting in the formation of cysts and abscesses. This type of acne is considered severe and often requires systemic treatment. Suspected cases should be referred to their physician. is an acute eruption of large inflammatory nodules, occurring most frequent in males. It also (...) frequently caused by topical steroid use. Skin infections such as (small fragile pustules; honey-coloured crusted erosions) o (red, often itchy, papules and/or pustules, occur at base of a hair shaft). Diagnosis of acne is based on the presence of comedones and / or inflammatory lesions. Patients with mild acne signs / symptoms generally do not require further investigation, however assessment by the patient's primary care provider is recommended in the following situations: Pregnancy Age < 12 years

2018 medSask

125. Shingles

to years after lesions heal (post-herpetic neuralgia). Occurs in approximately 0.4%-1% of adults per year. Cumulative lifetime incidence of 10-20% of the population. Shingles cannot be passed from one person to another. However, the VZV can be spread; someone who has never had chickenpox could develop chickenpox if exposed to someone with shingles. Transmission occurs via direct contact with the fluid from the blisters. A person is not contagious before blisters appear or after crusts develop over (...) , does not cross the body midline May involve any area of skin, but thoracic, cranial ( ), lumbar and cervical dermatomes most common Rash typically consists of macules or papules that evolve into vesicles or pustules: Begins with macule formation, quickly turns into papules Clear vesicles form within 1-2 days of rash onset; new ones appear over 3-5 days Vesicles evolve into pustules within 1 week Lesions ulcerate and crust 3-5 days later Healing occurs within 2 to 4 weeks (but may take longer

2018 medSask

126. Shingrix vaccine for herpes zoster

may be preceded by prodromal pain or itching, after which erythematous macules or papules appear. These progress into vesicular lesions, then into pustules. The pustules typically crust over within the course of about ten days. In many patients, the HZ rash heals and painful symptoms resolve entirely within about four weeks. 6 In up to about thirty percent of patients, however, the pain will persist for months beyond the initial rash, known as postherpetic neuralgia (PHN). 3 PHN is conventionally

2018 Therapeutics Letter

127. Guidelines of care for the management of cutaneous squamous cell carcinoma

measurement should exclude parakeratosis or scale/crust and should be made from base of the ulcer is present. If clinical evaluation of incisional biopsy suggests that microstaging is inadequate, consider narrow-margin excisional biopsy. Table IV Recommendations for grading and staging of cSCC Stratification of localized SCCs using the NCCN guideline framework is recommended for clinical practice. Clinicians should refer to the BWH tumor classification system to obtain the most accurate prognostication

2018 American Academy of Dermatology

128. Conjunctivitis (bacterial)

to Clinical Management Guideline on )] or sinusitis diabetes (or other disease compromising the immune system) steroids (systemic or topical, compromising ocular resistance to infection) blepharitis (or other chronic ocular inflammation) Symptoms Acute onset of: redness discomfort, usually described as burning or grittiness discharge (may cause temporary blurring of vision) crusting of lids (often stuck together after sleep and may have to be bathed open) Usually bilateral – one eye may be affected before (...) the other (by one or two days) Signs lid crusting purulent or mucopurulent discharge conjunctival hyperaemia – maximal in fornices tarsal conjunctiva may show mild papillary reaction cornea: usually no involvement (occasionally punctate epitheliopathy – mainly in lower third of cornea). If cornea significantly involved, consider possibility of gonococcal infection pre-auricular lymphadenopathy: usually absent Differential diagnosis Other forms of conjunctivitis epidemic keratoconjunctivitis (e.g

2018 College of Optometrists

129. Blepharitis

including blurred vision and contact lens intolerance Signs Anterior blepharitis (staphylococcal) lid margin hyperaemia lid margin swelling crusting of anterior lid margin (scales at bases of lashes) misdirection of lashes loss of lashes (madarosis) recurrent styes and (rarely) chalazia conjunctival hyperaemia secondary signs include: punctate epithelial erosion over lower third of cornea; marginal keratitis; phlyctenulosis; neovascularisation and pannus; mild papillary conjunctivitis Anterior (...) of the various lid hygiene regimes. There is evidence that long-term compliance with lid hygiene measures may be poor (GRADE*: Level of evidence = moderate, Strength of recommendation = strong) Wet warm compresses loosen collarettes and crusts in anterior blepharitis. Dry warm compresses melt meibum in posterior blepharitis (compress applied to lid skin twice daily for not less than 5 minutes at 40°C. Commercial products are available that are able to maintain temperatures in this region) (GRADE*: Level

2018 College of Optometrists

130. Basal cell carcinoma

Three clinical presentations in order of prevalence (commonest first) nodular (hard nodule, pearly appearance, abnormal (telangiectatic) vessels) nodulo-ulcerative (as nodular but with raised rolled border surrounding central ulcer, may bleed) morphoeic or sclerosing (flat hardened plaque of thickened skin, without surface vascularisation, ill-defined border making it difficult to determine area of involvement) Occasional secondary infection or inflammation overlying purulent discharge or crusting

2018 College of Optometrists

131. Herpes zoster ophthalmicus

a day to a week later General malaise, headache, fever Signs Skin features unilateral painful, red, vesicular rash on the forehead and upper eyelid, progressing to crusting after 2-3 weeks; resolution often involves scarring periorbital oedema (may close the eyelids and spread to opposite side) lymphadenopathy (swollen regional lymph nodes) lesion at the side of the tip of the nose (Hutchinson’s sign) indicates three times the usual risk of ocular complications, but these may also occur in one

2018 College of Optometrists

132. Atopic Eczema

. Barrier disruption leads to inflammation, and 12 protease-antiprotease imbalance is a crucial intermediate step (45). 13 14 Cleansing and bathing 15 The skin must be cleansed thoroughly, but gently and carefully to get rid of crusts and 16 mechanically eliminate bacterial contaminants in the case of bacterial super-infection. 17 Cleansers with or without antiseptics (the duration of action of antiseptics is very limited, 18 thus mechanical cleansing is probably more important) in non-irritant and low

2018 European Dermatology Forum

135. CRACKCast E120 – Dermatologic presentations

Thickened area of keratinised epithelium Crust Dried area of plasma proteins, resulting from inflammation Fissure Deep cracks in skin surfaces, extending into dermis Erosion Disruption of surface epithelium, usually linear, traumatic Ulcer Deep erosion extending into dermis Scar Dense collection of collage, a result of healing after trauma or procedures Excoriation Linear erosions typically secondary to scratching or rubbing Infections Bacterial, viral, fungal or protozoal infection, caused by breaks (...) Folliculitis [7] Describe treatment of poison ivy “Allergic contact dermatitis is a form of delayed hypersensitivity mediated by lymphocytes sensitized by the contact of the allergen to the skin.The common Toxicodendron species, including poison ivy, oak, and sumac can produce a severe reaction. Toxicodendron species often result in vesicular or bullous eruptions. Oozing, crusting, scaling, and fissuring may be found along with lichenification in chronic lesions. The distribution of the eruption depends

2017 CandiEM

136. Moisturisers improve eczema symptoms and lessen the need for corticosteroids

the opportunity to choose between different moisturisers and use the ones that suit them best. Some may prefer using less oily creams during the day and thicker ointments at night. Share your views on the research. Why was this study needed? Eczema is a chronic skin disorder characterised by itchy dry skin. Scratching and cracking lead to further damage with redness, crusts, and oozing, and the itching can result in sleep deprivation and have a considerable impact on quality of life. Eczema often develops (...) Task Force on Atopic Dermatitis. . Dermatology. 1993;186:23-31. NICE. . London: National Institute for Health and Clinical Excellence; 2007. SIGN. . Edinburgh: Scottish intercollegiate guidelines network; 2011. Why was this study needed? Eczema is a chronic skin disorder characterised by itchy dry skin. Scratching and cracking lead to further damage with redness, crusts, and oozing, and the itching can result in sleep deprivation and have a considerable impact on quality of life. Eczema often

2019 NIHR Dissemination Centre

137. CRACKCast E137 – Skin Infections

that extends through the epidermis into the dermis. It is manifested as ulcers with a punched-out appearance, with raised reddened margins covered with thick crust. It has a predilection for the lower extremities. Unlike impetigo, ecthyma can result in cutaneous scarring. Treatment: Mild-moderate non-bullous impetigo = topical mupirocin TID for 5 days Severe impetigo, bullous impetigo, ulcerative impetigo = Staph and MRSA coverage: Clindamycin AND Septra Cephalexin AND Septra [2] What is the eagle effect

2017 CandiEM

138. CRACKCast E130 – Viruses

, FACE, and FEET Primary varicella: Chickenpox is a febrile illness characterized by malaise and rash. The rash begins first on the scalp and face and then spreads to the trunk and extremities. (rarely involves the hands and feet) The lesions start as maculopapular, and progress to fluid filled vesicles that eventually crust over and form scabs. The lesions occur as crops at various stages of development. Patients are contagious until all lesions are scabbed over, which can typically take 1 to 2

2017 CandiEM

139. CRACKCast E071 – Ophthalmology Part A

SYSTEMIC extension of the infections require IV abx 4) Describe typical features of conjunctivitis and management options Conjunctivitis #1 cause of a red eye Symptoms: Redness, FB sensation, lid swelling, eye crusting, drainage NO photophobia, NO visual loss Caseus: Viral, bacterial, mechanical, allergic, toxic Called KERATOconjunctivitis when the cornea is involved as well Most commonly viral Bacterial causes: Pneumoniae, H. influenzae, Staph, Moraxella, Neisseria gonorrhoeae, Klebsiella, Pseudomonas (...) eyelid margins with pronounced blood vessels NOT an infection., just an inflammation VERY common! Symptoms: Eye burning, itching, tearing, FB sensation, morning crusting Treatment: Rubbing eyelid margins with mild shampoo + cloth Warm compresses QID Severe: topical abx 9) Compare periorbital and orbital cellulitis PEX and treatment — See — Orbital Cellulitis Etiology Symptoms Important differences to periorbital cellulitis Maxillary/ethmoid sinusitis Orbital trauma Dental Infection Need CT to rule

2017 CandiEM

140. Guidelines for care of patients with actinic keratosis

/amenability; ??? very ?exible/amenable. First hospital clinic attendance NHS tariff 2014–15: £104. 178 Hospital follow-up attendance: £68. GP visit: £44. 179 © 2017 British Association of Dermatologists British Journal of Dermatology (2017) 176, pp20–43 28 Guidelines for actinic keratosis 2017, D. de Berker et al.8.2 Active treatments All topical therapies for AK may result in side-effects of irrita- tion. Some AKs proceed to ooze, crusting and soreness with local swelling. Details are cited (...) and low-cost treatment. 63 It can be used either as lesional treatment or as part of ?eld treat- ment. The side-effects with the latter can be substantial, and it is important that the patient is counselled about them, includ- ing soreness, redness and possible crusting. All of these can be minimized through reduction in the frequency of application or short breaks in a course of therapy. It is permitted to wash the area and apply thin emollient. If the reaction is excessive, weak steroid can

2017 British Association of Dermatologists

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