A 17-year-old female presents with multiple comedones, pustules and papules on her face.
Which one of the following is least likely to improve her condition?
Correct Answer B: There is no role for dietary modification in patients with acne vulgaris. Ethinylestradiol with cyproterone acetate (Dianette) is useful in some female patients with acne unresponsive to standard treatment. Oral trimethoprim is useful in patients on long-term antibiotics who develop Gram negative folliculitis.
Acne vulgaris: management:
Acne vulgaris is a common skin disorder which usually occurs in adolescence. It typically affects the face, neck and upper trunk and is characterized by the obstruction of the pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules.
Acne may be classified into mild, moderate or severe:
A simple step-up management scheme often used in the treatment of acne is as follows:
There is no role for dietary modification in patients with acne.
Each of the following drugs may be used in psoriasis, except:
Correct Answer A: SIGN released guidelines in 2010 on the management of psoriasis and psoriatic arthropathy. Please see the link for more details.
Psoriasis: management:
Chronic plaque psoriasis:
Steroids in psoriasis:
Scalp psoriasis:
Secondary care management:
Phototherapy:
Systemic therapy:
Mechanism of action of commonly used drugs:
A 34-year-old female with a history of discoid lupus erythematous is reviewed in clinic. The erythematous, scaly rash on her face has not responded to topical steroid creams.
What is the most appropriate next step in management?
Correct Answer B: Discoid lupus erythematous - topical steroids --> oral hydroxychloroquine.
Discoid lupus erythematous:
Discoid lupus erythematous is a benign disorder generally seen in younger females. It very rarely progresses to systemic lupus erythematosus (in less than 5% of cases). Discoid lupus erythematous is characterized by follicular keratin plugs and is thought to be autoimmune in etiology.
Features:
Management:
The eruption consists of erythematous patches covered with an adherent hyperkeratotic layer, predominantly at the hair follicles. It resolves into cicatricial atrophy.
A 35-year-old female presents tender, erythematous nodules over her forearms. Blood tests reveal: Calcium 2.78 mmol/l.
What is the most likely diagnosis?
Correct Answer B: The likely underlying diagnosis is sarcoidosis.
Erythema nodosum:
Overview:
Causes:
A 62-year-old woman mentions in diabetes clinic that she has a 'volcano' like spot on her left cheek, which has appeared over the past 3 months. She initially thought it may be a simple spot but it has not gone away. On examination she has a 5 mm red, raised lesion with a central keratin filled crater. A clinical diagnosis of probable keratoacanthoma is made.
What is the most suitable management?
Correct Answer B: Whilst keratoacanthoma is a benign lesion it is difficult clinically to exclude squamous cell carcinoma so urgent excision is advised.
Keratoacanthoma:
Keratoacanthoma is a benign epithelial tumour. They are more frequent in middle age and do not become more common in old age (unlike basal cell and squamous cell carcinoma).
Features - said to look like a volcano or crater:
Spontaneous regression of keratoacanthoma within 3 months is common, often resulting in a scar. Such lesions should however be urgently excised as it is difficult clinically to exclude squamous cell carcinoma. Removal also may prevent scarring.
Very well defined nodule surmounted by a central horny plug. Its growth is rapid, the maximum size of the lesion being reached in a few weeks. The lesion usually regresses spontaneously in a few months.
Click to expand