A 23-year-old man presents with an itchy skin condition.
Which one of the following is not part of the UK Working Party Diagnostic Criteria for atopic eczema?
Correct Answer B: Whilst response to topical steroids provides useful clinical information it is not part of the diagnostic criteria. A wide variety of skin conditions can improve with topical steroid therapy.
Eczema: diagnosis :
UK Working Party Diagnostic Criteria for Atopic Eczema .
An itchy skin condition in the last 12 months Plus three or more of:
*not used in children under 4 years
**or dermatitis on the cheeks and/or extensor areas in children aged 18 months or under
***in children aged under 4 years, history of atopic disease in a first degree relative may be included
A 62-year-old with a history of acne rosacea presents for advice regarding treatment.
Which one of the following interventions has the least role in management?
Correct Answer C: Acne rosacea is a chronic skin disease of unknown aetiology.
Acne rosacea
Features:
Management:
Rosacea on the mid-face with periorbital sparing.
Persistent erythema in the centro-facial area.
A 26-year-old man who is HIV positive is noted to have developed seborrhoeic dermatitis.
Which of the following two complications are most associated with this condition?
Correct Answer B: Alopecia is not commonly seen in seborrhoeic dermatitis, but may develop if a severe secondary infection develops.
Seborrhoeic dermatitis in adults: Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.
Associated conditions include:
Scalp disease management:
Face and body management:
Severe facial seborrhoeic dermatitis with prominent involvement of the naso-labial grooves.
Seborrhoeic dermatitis of the presternal area.
Seborrhoeic dermatitis of the axilla. The large flexures may become secondarily infected.
Perinasal seborrhoeic dermatitis with distinct erythematous patches and scaling, extending on the cheeks.
A 26-year-old male presents with a rash. Examination reveals erythematous oval lesions on his back and upper arms which have a slight scale just inside the edge. They vary in size from 1 to 5 cm in diameter.
What is the most likely diagnosis?
Correct Answer D: The skin lesions seen in pityriasis rosea are generally larger than those found in guttate psoriasis and scaling is typically confined to just inside the edges.
Pityriasis rosea
Overview:
pityriasis rosea with herald patch on the right of the chest.
pityriasis rosea Herald Patch close-up.
Second recurrence of pityriasis rosea – herald patch indicated by the white arrow.
Which of the following statements regarding psoriasis is incorrect?
Correct Answer C: Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells.
Psoriasis: Psoriasis is a common and chronic skin disorder. It generally presents with red, scaly patches on the skin although it is now recognized that patients with psoriasis are at increased risk of arthritis and cardiovascular disease.
Pathophysiology:
These cells seem to be a third T-effector cell subset in addition to Th1 and Th2:
Recognized sub-types of psoriasis:
Other features:
Complications:
Psoriasis is characterized by well-demarcated red scaly plaques.
Most plaques of psoriasis are surmounted by silvery white scaling, which varies considerably in thickness.
In dark-skinned races, the quality of the colour is lost.
Submammary flexural psoriasis.
On the soles, psoriasis may present as typical scaly plaques.
On the palms, psoriasis may present as typical scaly plaques.
Marked psoriatic subungual hyperkeratosis.
Extensive lesions of guttate psoriasis in a young man.
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