Spot Diagnoses 2 by sammyc2007

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									Answer – Dermatitis Artefacta (1point)
♦ Lesions emerge almost overnight ♦ Found on sites that are accessible to the patient's hands ♦ Bizarre shapes with irregular outlines in a linear or

geometric pattern

♦ Lesions range from red patches, swelling, blisters, denuded

areas, crusts, cuts, burns, and scars.

♦ Usually clearly demarcated from surrounding normal skin ♦ The patient will usually deny that the rash is self induced

What ‘simple’ investigations would you check if such a patient complained of a general itch? - 5 points max
♦ (Dermographism & general examination) ♦ FBC – Anaemia, polycythemia ♦ SMAC – Renal failure, thyroid disease ♦ Ferritin – Can be low even if FBC/indices normal ♦ Urinalysis – Urological disease ♦ CXR - Lymphoma

♦ If tests are normal and patient otherwise

well – No further investigation warranted.
♦ But beware of the following patient

……………

Facial rashes

• 30 yr old female • Intermittent flushing • Pustules but no comedones •What is the diagnosis? Answer: - Rosacea 1 point

Rosacea
♦ Adults ♦ Flushing: Intermittent – permanent ♦ Spots but no comedones ♦ Sparing peri-oral & peri-orbital ♦ Treatment:

- Topical agents - Low dose long-term antibiotics - Laser

What is the diagnosis of this rash made worse by the use of topical steroids? Answer: Peri-oral dermatitis 1 point

Peri-oral dermatitis
♦ Red papules around mouth / eyes ♦ Women > men +++ ♦ Redness in naso-labial fold ♦ Aggravated by steroids (as is rosacea) ♦ Treatment:

- (Topical antibiotics) - 6 week courses of systemic tetracycline / eryth

• What is the diagnosis?

Answer: - Seborrheoic dermatitis 1 point

Seborrhoeic dermatitis
♦ Scalp – mildly red and scaly ♦ Skin – N/L folds, eyebrows, behind ears, central

trunk, skin folds

♦ If severe – Rule out HIV ♦ Treat:

- Emollients - Ketoconazole shampoo / cream - Daktacort/topical steroids? - Short course of itraconazole 100mg OD 2 weeks - Medium term tetracycline (lymecycline)

What has happened here & name the likely cause Answers: Contact allergic dermatitis & PPD 2 points

• What two things have caused this reaction? Answers: - Medication (Sulphonamide) & - Sun 2 points

• 48 yr old female • Gradual onset • Red plaques • Scarring • What is the diagnoses? Answer: - DLE 1 point

A N Y T H I N G G O E S

• 27 yr old male
• Mainly trunk • Not respond to light What is the diagnosis & what is the affect of a woods light Answers: Pityriasis vesicolor & yellow-green 2 points

Treatment of pityriasis vesicolor
♦ Ketoconazole shampoo:

- 4 times a week for 2 week - Then once a month
♦ Itraconazole tabs 200mg OD for a week ♦ Time!

• 19yr old male
• Mild itch • Fine rim of scale What is the diagnosis and what is the name of this? Answers: - Pityriasis rosea - Herald Patch 2 points

What has happened here? Answer: Phytophotodermatits 1 point

What is the diagnosis? Answer: Tinea Pedis 1 point

Tinea
♦ Unilateral ♦ Scaling ♦ Topical steroids! ♦ Nail clippings

What is the diagnosis?

1 point

Answer: Palmoplantar pustular psoriasis

What is the diagnosis and what is the association? Answers: Necrobiosis lipodica and diabetes 2 points

NL • Female > Male • Young adults & middle age • Most pre-tibial •Atrophic yellow patch with red edge • Many persist and may ulcerate

What is the diagnosis and what might you find on the nails? 2 points

Alopecia Areata - 1 point
♦ Teenager / Young adult ♦ Non-scarring & Exclamation mark hairs ♦ Scalp / Any other hair baring area ♦ Nails – Pits: 1 point ♦ Re-growth in the majority by 1 year

• Smooth patch on top of scalp • Present since birth •What is the diagnosis? Answer: - Naevus Sebaceous 3 points

Its on the way back – What is the diagnosis?

Syphilis – 1 Point
♦ Rash occurs 3 weeks - 3 months after 1 stage ♦ Widespread rash, which may be subtle or
st

appear as rough, red or reddish brown spots. ♦ Occur anywhere on the body but frequently affects palms and soles. May be mistaken for other conditions. ♦ Patchy ‘moth-eaten’ hair loss. ♦ Raw and red mucosal surfaces e.g.mouth, throat, genital area, vagina and anus ♦ Other symptoms include fever, tiredness, muscle and joint pains, headache and swollen lymph glands.

Skin lesions

What is the diagnosis of this rough leison on sun-exposed skin? Answer: Actinic keratosis (Solar keratoses) 1 point


								
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