A 50-year-old man with a history of ulcerative colitis comes for review. Six years ago he had an ileostomy formed which has been functioning well until now. Unfortunately he is currently suffering significant pain around the stoma site. On examination a deep erythematous ulcer is noted with a ragged edge. The surrounding skin is erythematous and swollen.
What is the most likely diagnosis?
Correct Answer C: Pyoderma gangrenosum is associated with inflammatory bowel disease and may be seen around the stoma site.
Treatment is usually with immunosuppressants as surgery may worsen the problem A differential diagnosis would be malignancy and hence lesions should be referred for specialist opinion to evaluate the need for a biopsy. Irritant contact dermatitis is common but would not be expected to cause such a deep ulcer.
Pyoderma gangrenosum:
Features:
Causes*:
Management:
*Note whilst pyoderma gangrenosum can occur in diabetes mellitus it is rare and is generally not included in a differential of potential causes
A 22-year-old woman presents due to hypopigmented skin lesions on her chest and back. She has recently returned from the south of France and has tanned skin. On examination the lesions are slightly scaly.
Correct Answer B: Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale).
Predisposing factors:
A 67-year-old man with a history of Parkinson's disease presents due to the development of an itchy, red rash on his neck, behind his ears and around the nasolabial folds. He had a similar flare up last winter but did not seek medical attention.
Correct Answer B: Seborrhoeic dermatitis is more common in patients with Parkinson's disease.
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:
A 43-year-old man comes for review. A few months ago he developed redness around his nose and cheeks. This is worse after drinking alcohol. He is concerned as one of his work colleagues asked him if he had a drink problem despite him drinking 14 units per week. On examination he has erythema as described above with some pustules on the nose and telangiectasia on the cheeks.
Correct Answer D: This is a typical history of acne rosacea.
Acne rosacea:
Acne rosacea is a chronic skin disease of unknown aetiology.
Inflamed papules and aseptic pustules appear on a background of telangiectatic erythema, but never comedones (which necessarily leads to rejection of the term "acne rosacea").
A 19-year-old student presents with a three day history of a 1 cm golden, crusted lesion on the border of her lower lip.
What is the most suitable management?
Correct Answer E: Impetigo - topical fusidic acid --> oral flucloxacillin / topical retapamulin.
This history is typical of impetigo. As the lesion is small and localized topical fusidic acid is recommended.
Impetigo management: Limited, localized disease:
Extensive disease:
Staphylococcal impetigo
Bullous Impetigo
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