A 74-year-old lady with a history of hypothyroidism presents in January with a rash down the right side of her body. On examination an erythematous rash with patches of hyperpigmentation and telangiectasia is found.
What is the likely diagnosis?
Correct Answer D: This is a classic presentation of erythema ab igne. Despite the name, pretibial myxoedema is associated with hyperthyroidism rather than hypothyroidism.
Hypothyroidism can make patients feel cold and hence more likely to sit next a heater / fire.
Erythema ab igne is a skin disorder caused by over exposure to infrared radiation. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia. A typical history would be an elderly women who always sits next to an open fire.
If the cause is not treated then patients may go on to develop squamous cell skin cancer.
Erythema ab igne with subepidermal bulla formation.
A 28-year-old man presents with multiple protuberant lesions around the anus which have been present for about 6 weeks. He reports it is painful when he passes a stool although there is no change in bowel habit.
What is the most likely diagnosis?
Correct Answer C: Ambiguous questions such as this are common in the MRCP. Whilst a case could be made for any of the answers the most likely cause from the above list, in a 28-year-old male, is genital warts.
Genital warts (also known as condylomata accuminata) are a common cause of attendance at genitourinary clinics. They are caused by the many varieties of the human papilloma virus HPV, especially types 6 & 11. It is now well established that HPV (primarily types 16,18 & 33) predisposes to cervical cancer.
Features:
Management:
A 25-year-old man presents with a widespread rash over his body. The torso and limbs are covered with multiple erythematous lesions less than 1 cm in diameter which in parts are covered by a fine scale. You note that two weeks earlier he was seen with to a sore throat when it was noted that he had exudative tonsillitis. Other than a history of asthma he is normally fit and well.
Correct Answer E: Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
Extensive lesions of guttate psoriasis in a young man.
A 25-year-old man presents with a pruritic skin rash. This has been present for the past few weeks and has responded poorly to an emollient cream. The pruritus is described as 'intense' and has resulted in him having trouble sleeping. On inspecting the skin you notice a combination of papules and vesicles on his buttocks and the extensor aspect of the knees and elbows.
Correct Answer D: Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
Diagnosis:
Dermatitis herpetiformis. Intact tense bullae on the elbow.
Dermatitis herpetiformis. Direct immunofluorescence demonstrating granular IgA deposition in the dermal papillae.
A 54-year-old man is referred to the dermatology outpatient department due to a facial rash which has persisted for the past 12 months. On examination there is a symmetrical rash consisting of extensive pustules and papules which affects his nose, cheeks and forehead.
What is the most appropriate treatment?
Correct Answer C:
Acne rosacea treatment:
Acne rosacea is a chronic skin disease of unknown aetiology.
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