A 48-year-old man with a history of psoriasis develops plaques on his face. Of the following options, which one is the most appropriate treatment?
Correct Answer A: Difficult question, particularly as there is an emphasis on patient-doctor choice when deciding upon treatment in psoriasis. Vitamin D analogues can be used in this situation but calcipotriol is not recommended as it may cause irritation - calcitriol and tacalcitol are alternatives. Mild potency topical steroids are useful for the management of facial psoriasis. Coal tar is smelly and messy - most patients would not tolerate facial application.
Psoriasis: management:
SIGN released guidelines in 2010 on the management of psoriasis and psoriatic arthropathy. Please see the link for more details.
Chronic plaque psoriasis:
Steroids in psoriasis:
Scalp psoriasis:
Secondary care management:
Phototherapy:
Systemic therapy:
Mechanism of action of commonly used drugs:
A 22-year-old male is referred to dermatology clinic with a longstanding problem of bilateral excessive axillary sweating. He is otherwise well but the condition is affecting his confidence and limiting his social life.
What is the most appropriate management?
Correct Answer D: Hyperhidrosis describes the excessive production of sweat.
Hyperhidrosis Management options include:
A 23-year-old man presents with a 4 day history of an itchy and sore right ear. He has recently returned from holiday in Spain. On examination the right ear canal is inflamed but no debris is seen. The tympanic membrane is clearly visible and is unremarkable.
Correct Answer A: This patient has otitis externa, which commonly develops after swimming on holiday. The first line management is either a topical antibiotic or a combined topical antibiotic and steroid.
Otitis externa is a common reason for primary care attendance in the UK.
Causes of otitis externa include:
Features:
The recommend initial management of otitis externa is:
Second line options include:
Malignant otitis externa is more common in elderly diabetics. In this condition there is extension of infection into the bony ear canal and the soft tissues deep to the bony canal. Intravenous antibiotics may be required.
*Many ENT doctors disagree with this and feel that concerns about ototoxicity are unfounded.
Acute otitis externa. The external auditory canal appears swollen with skin debris and some otorrhea.
Right ear. Malignant otitis externa in a 60-year-old patient affected by type I diabetes.
A 29-year-old man consults you regarding a rash he has noticed around his groin. It has been present for the past 3 months and is asymptomatic. On examination there is a symmetrical well demarcated, brown-red macular rash around the groin.
What is the most likely diagnosis?
Correct Answer A: Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum.
Examination with Wood's light reveals a coral-red fluorescence. Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection.
Erythrasma Axilla.
Wood’s light illumination of erythrasma of the groins – the fluorescence is coral pink.
Which one of the following conditions is least associated with Photosensitivity?
Correct Answer D: Photosensitivity is not a feature of acute intermittent porphyria unlike porphyria cutanea tarda.
Photosensitive skin disorders
Diseases aggravated by exposure to sunlight:
Porphyria cutanea tarda: erosions, blisters, pigmentary changes and scarring.
Hair loss and photosensitivity caused by systemic lupus erythematosus.
Skin reddening (erythema) following acute UV radiation (intense natural sunlight) exposure (‘sunburn’).
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