Dermatology (Erysipelas/Psoriasis) & Depression

Question 1

What is Erysipelas and what is it caused by?

Answer 1

• S. pyogenes.
• skin lession

Wikipedia:

Erysipelas is a relatively common bacterial infection of the superficial layer of the skin (upper dermis), extending to the superficial lymphatic vessels within the skin, characterized by a raised, well-defined, tender, bright red rash, typically on the face or legs, but which can occur anywhere on the skin.

Erysipelas is usually caused by the bacteria Streptococcus pyogenes, also known as group A β-hemolytic streptococci, through a break in the skin such as from scratches or an insect bite.

Question 2

Erysipelas - signs and symptoms

Answer 2

• Much wider area of limb skin involvement.

• General symptoms, patient usually has
elevated body temperature, reaching 39-40 °C.

• In thrombophlebitis, the temperature of the
body may be elevated, but not so much.

Question 3

Erysipelas - Treatment

Answer 3

• Procaine penicillin in a dose of 1 200 000 - 2 400 000 IU daily, intramuscularly.
• Oral: (e.g. Ospen 1500 3x1)
• Local: ichthyol ointment

Question 4

Psoriasis

Present as…

What type of dermatologic condition is it?
Where can it be located?
What is Koebner’s symptom/phenomenon

Answer 4

• Punctic hollows, subungual linear
hemorrhages, “oil spots”, yellow-gray or
silvery-white nails

• Erythematous papule exfoliation
• Knees, elbows, scalp, gluteal fissure, lumbar
area, navel
• Koebner’s symptom, that is, the inoculation of
typical changes in the place of even minor skin
trauma

The Koebner phenomenon describes the formation of skin lesions on parts of the body where a person doesn’t typically experience lesions. This is also known as an isomorphic response.
(https://www.healthline.com/health/koebner-phenomenon-psoriasis)

• character of thimble pits, yellow “oil patches”
associated with subungual keratosis, up to the
complete destruction of nail plates
• more likely hands than in the case of fungal
lesions
• more than one nail
• changes in the scalp, the hair is usually not
damaged, and often the opposite - very dense
and strong

Question 5

Psoriasis (Wikipedia)

Characterized by…
What is the Koebner phenomenon?

Answer 5

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, or purple on some people with darker skin, dry, itchy, and scaly.

Psoriasis varies in severity from small, localized patches to complete body coverage.

Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

Question 6

Psoriasis (Wikipedia)

Types of Psoriasis

Answer 6

The five main types of psoriasis are plaque, guttate, inverse, pustular, and erythrodermic.

• Plaque psoriasis, also known as psoriasis vulgaris, makes up about 90% of cases. It typically presents as red patches with white scales on top. Areas of the body most commonly affected are the back of the forearms, shins, navel area, and scalp.
• Guttate psoriasis has drop-shaped lesions.
• Pustular psoriasis presents as small, noninfectious, pus-filled blisters.
• Inverse psoriasis forms red patches in skin folds.
• Erythrodermic psoriasis occurs when the rash becomes very widespread, and can develop from any of the other types.

Fingernails and toenails are affected in most people with psoriasis at some point in time. This may include pits in the nails or changes in nail color.

Question 7

Psoriasis (Wikipedia)

Treatment

Answer 7

No cure for psoriasis is known, but various treatments can help control the symptoms.

These treatments include steroid creams, vitamin D3 cream, ultraviolet light, and immunosuppressive drugs, such as methotrexate.

About 75% of skin involvement improves with creams alone.

Question 8

Criteria ICD-10 - Depression

Answer 8

A. General criteria for depressive episode.

1. The depressive episode should last for at least two weeks.
2. The episode is not attributable to psychoactive substance use or to any organic mental disorder.

B. Presence of at least two of the following symptoms

1. Depressed mood to a degree that is absolutely for the individual, present for most of the day and almost every day.
2. Marked loss of interest or ability to enjoy activities that were previously pleasurable.
3. Decreased energy or increased fatigability.

C. Additional symptoms from the following, at least four

1. Loss of confidence and selfesteem, and feelings of inferiority.
2. Unreasonable feelings of self-reproaches or excessive and inappropiate guilt.
3. Recurrent thoughts of death or suicide or any suicidal behaviour.
4. Diminished ability to concentrate.
5. Change in psychomotor activitywith with agitation or inhibition.
6. Sleep disturbances
7. Changes in appetite

Question 9

Depression - Treatment

First-line treatment
SSRIs and their doses

Answer 9

First-line treatment is SSRI

• * Citalopram**
  (e. g. Citronil, Citabax initially 10-20mg, therapeutic 20-60mg)
• * Fluoxetine**
  (e. g. Fluxemed, Deprexetin initially 20mg, therapeutic 10-80mg)
• * Paroxetine**
  (e. g. Paroxinor, Paxtin initially 10-20mg, therapeutic 10-50mg)
• * Sertraline**
  (e. g. Asertin, Sastium initially 25-50mg, therapeutic 50 -200mg)