Skin Lumps and Bumps

1. Skin Lumps and Bumps Jo Swallow

3. Contact Dermatitis

6. Scabies • Transmission occurs by skin-to-skin contact. It is a common condition and is pandemic. • female scabies mites live for 4-6 weeks; they lay 1-3 eggs per day and burrow at a rate of 2-3 mm per day • each egg hatches within 3-4 days - when the egg hatches the larva escapes from the burrow (via cutting through the roof and then digging short burrows • the hatched larva remains on the skin surface and remains there until maturity; it takes 10-13 days from the laying of the egg to maturation of adult scabies mite

7. Scabies 2 • Classically, greyish white linear burrows may be seen on the finger webs, sides of the fingers, wrists, elbows, anterior axillary fold, periumbilical area, and areolae. • Burrows are rarely seen on the buttocks and male genitalia - instead, there are firm, red papules. • Severe and persistent itch • often worse at night and following bathing

8. Scabies 3 • this indicates that hypersensitivity has developed • first attack the incubation period is 2-6 weeks • much shorter in subsequent attacks - possibly as short as 24 hours. • In children under 2 years of age, scabies infestation commonly presents as vesicular lesions

9. Scabies 4 • use permethrin 5% dermal cream first-line unless contraindicated, as this is best supported by evidence • the application can be washed off in a hot bath after 8-12 hours • permethrin or malathion should be applied twice, 1 week apart • Pruritus may continue for several days

11. Varicella • fever and a rash • incubation period is from 14 up to 21 days • chicken pox is infectious from a few days before the onset of rash develops and not more than six days after first lesions appear • rash is macular, papular, or vesicular depending on age

12. Varicella 2 • bathe the lesions with calamine lotion • Oral aciclovir may also be given to to immuocompetent adults and older adolescents with chickenpox; aciclovir is not generally indicated for immunocompetent children • Immunosuppressed patients should be given immunoglobulin to varicella zoster • and aciclovir

13. 90% of women have antibodies to varicella zoster virus • In non immune - associated with fetal and maternal morbidity and mortality • fetal varicella syndrome risk >12-28wks • Maternal lung involvement 15%

14. Varicella 3 • assay varicella zoster antibodies if suspected exposure • tested by urgent serology • if chickenpox in pregnancy, or a woman is varicella zoster (VZ) antibody negative and is exposed consult expert advice • VZ antibody negative and exposed • zoster immune globulin should be given • up to 10 days after

16. actinic keratosis • most common premalignant skin condition • multifocal scaly, hyperpigmented or scaly lesions, usually brown with a scaly base • thickening of the keratin layer • basal layer remains intact • there is debate whether actinic keratoses are premalignant conditions or alternatively early-stage squamous cell carcinoma (SCC

17. Actinic keratosis • middle-aged or elderly • outdoor workers • fair-skin • lesions found on sun-exposed parts e.g. face, neck, hands • generally flat, well-demarcated, brown (sometimes red), crusty or scaly lesions • lesion that loses its scale but then recurs

18. Actinic keratosis • cryotherapy, curettage, local excision • topical cytotoxic preparations • (e.g. 5-fluorouracil), • topical retinoids, • salicylic acid in emulsifying ointment, • topical diclofenac gel (this is licensed for treatment of actinic keratosis in the UK)

20. Pyogenic granuloma • The lesion develops over a period of about one week. • Common sites are the feet and hands, also the lips and gums • remove

22. Xanthomata • localised collections of lipid-laden foam cells • caused by raised levels of lipoproteins and, or, lipids.

25. Lipoma • the commonest benign tumours. • common on the trunk and shoulder • not found on the palm of the hand or the soles of the feet. • they are found at all tissue planes • A rare complication of lipomata is a liposarcoma.

28. Ganglion • 'cyst' arising from a joint or tendon sheath • painless lump • well-defined and not tender • may disappear after some months without treatment. • If the lump is troublesome then it may be aspirated. • If the lump recurs it may be injected with steroids.

30. Kaposi’s sarcoma • Ashkenazi Jews • immunocompromised patients • malignant neoplastic vascular proliferation, characterised by the development of bluish-red nodules on the skin. • may at first appear like bruises • become slightly raised and firmer, with the colour darkening so that the lesions become purple and black

32. ~Warts • benign tumours of the epidermis induced by inoculation of specific papilloma viruses • Plantar warts • Plane warts • Common warts • Filiform warts • Genital warts

35. Molluscum • viral skin disease characterised by firm, round, translucent papules • DNA virus of pox family • Papules are mildly pruritic or asymptomatic • may resolve spontaneously in 2 - 3 months. • topical 0.5% podophyllotoxin • Prevention of spread is achieved by use of separate towels and other measures of basic hygeine.

36. Sebaceous cyst • result of growth of epidermal cells within the dermis. • most common locations are the trunk, neck, face and scalp • the cyst may become secondarily infected • punctum - blocked duct - may be visible

37. Chalazion • cyst of the Meibomian gland • firm, painless lump in the lid which gradually enlarges • A third of cases will resolve spontaneously and virtually all will resorb within two years.

38. Stye • infection of the glands of the eyelids • due to staphylococcus aureus • It corresponds to a boil of the skin elsewhere • Pain, redness and swelling are the principal symptoms • Heat and topical antibiotic ointment (e.g. fusidic acid)