A 36-year-old woman is reviewed. She presented 4 weeks ago with itchy dry skin on her arms and was diagnosed as having atopic eczema. She was prescribed hydrocortisone 1% cream with an emollient. Unfortunately there has been no improvement in her symptoms.
What is the next step in management, alongside continued regular use of an emollient?
Correct Answer B:
Topical steroids:
Clobetasone butyrate 0.05% is a moderately potent topical steroid and would be the most suitable next step in management. It is important to note the potency difference between two very similar sounding steroids - Clobetasone butyrate 0.05% (moderate) and Clobetasol propionate 0.05% (very potent).
Eczema: topical steroids: Use weakest steroid cream which controls patients symptoms The table below shows topical steroids by potency:
Finger tip rule:
Topical steroid doses for eczema in adults:
The BNF makes recommendation on the quantity of topical steroids that should be prescribed for an adult for a single daily application for 2 weeks:
A 54-year-old man presents with a brown velvety rash on the back of his neck around his axilla. A clinical diagnosis of acanthosis nigricans is made.
Which one of the following conditions is most associated with this kind of rash?
Correct Answer A:
Acanthosis nigricans
Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.
Causes:
A 67-year-old man who is a retired builder presents following the development of a number of red, scaly lesions on his left temple. These were initially small and flat but are now erythematous and rough to touch.
What is the most likely diagnosis?
Correct Answer D: Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure.
Actinic keratoses
Features:
Management options include:
A 85-year-old lady presents to dermatology clinic complaining of itchy white plaques affecting her vulva. There is no history of vaginal discharge or bleeding. A similar plaque is also seen on her inner thigh.
What is the likely diagnosis?
Correct Answer C: The correct answer is lichen sclerosus. Candida may cause pruritus and white plaques but lesions would not also be seen on her inner thigh.
Lichen:
Lichen sclerosus:
Lichen sclerosus was previously termed lichen sclerosus et atrophicus. It is an inflammatory condition which usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming.
A biopsy is often performed to exclude other diagnoses
Management:
Scarring in lichen sclerosus with mild ecchymosis.
Scarring in lichen sclerosus with loss of the labia minora and sealing of the clitoral hood.
Squamous cell carcinoma arising on a background of lichen sclerosus.
Typical lichen planus with trachyonychia, onychorrhexia and onycholysis.
Erosive lichen planus.
A 26-year-old newly qualified nurse presents as she has developed a bilateral erythematous rash on both hands. She has recently emigrated from the Philippines and has no past medical history of note. A diagnosis of contact dermatitis is suspected.
What is the most suitable to test to identify the underlying cause?
Correct Answer E: The skin patch test is useful in this situation as it may also identify for irritants, not just allergens.
Allergy tests:
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