Day 5 Derm Flashcards
A 45-year-old man presents to his general practitioner with a one-week history of a rash. He has recently returned from a holiday in Spain. He does not have any significant past medical history and does not take any regular medications.
On examination, there is a rash affecting his trunk, consisting of multiple hypopigmented patches, which are slightly scaly.
Based on the likely diagnosis, what is the appropriate treatment?
Ketoconazole shampoo is used to treat pityriasis versicolor
A 72-year-old woman is diagnosed with a number of erythematous, rough lesions on the back of her hands.
What is the diagnosis?
What is the management?
actinic keratoses
Topical fluorouracil cream
A 43-year-old woman comes for review. A few months ago she developed redness around her nose and cheeks. This is worse after drinking alcohol. She is concerned as one of her work colleagues asked her if she had a drink problem despite her drinking 10 units per week.
Acne rosacea features:
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules
A 36-year-old female with a history of ulcerative colitis She presented 4 days ago with a 3 cm lesion on her right shin which rapidly ulcerated and is now painful:
pyoderma gangrenosum
Oral prednisolone
A 20-year-old lady is referred to the vascular clinic. She has been feeling generally unwell for the past six weeks. She works as a typist and has noticed increasing pain in her forearms whilst working.
- On examination she has absent upper limb pulses.
- Her ESR is measured and mildly elevated.
The correct answer is: Takayasu’s arteritis
Takayasus arteritis may be divided into acute systemic phases and the chronic pulseless phase.
In the latter part of the disease process the patient may complain of symptoms such as upper limb claudication.
In the later stages of the condition the vessels will typically show changes of intimal proliferation, together with band fibrosis of the intima and media.
A 28-year-old Caucasian male presents with itchy red spots on is abdomen, back and arms, which he reports appeared quite suddenly.
He has no significant past medical history, but states he had a sore throat a few weeks ago.
On examination, you notice he has a white pus-like discharge over his palatine tonsils.
He states that he a similar rash last winter, when he had a sore throat.
Streptococcal throat infection may precipitate psoriasis (particularly guttate psoriasis). Patients with frequent exacerbations of guttate psoriasis due to streptococcal throat infections may benefit from tonsillectomy
A 32-year-old female presents to her general practitioner with worsening blistering of the fingers and palms of both hands. She has a past history of blistering and fissuring of her hands and recently returned from a holiday in a foreign country with a hot, humid environment. Examination identifies numerous areas of irritable, erythematous vesicles on the palms of both hands.
What is the most likely diagnosis?
Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures
A 68-year-old farmer presents with a skin lesion on his forehead.
It has been present for the past 6 months and has grown slightly in size during that time.
On examination he has an ulcerated lesion with pearly white raised edges that measures 2cm in diameter.
The correct answer is: Basal cell carcinoma
The raised pearly edges in an ulcerated lesion at a sun exposed site makes BCC most likely.
A 25-year-old man presents with a pruritic skin rash. This has been present for the past few weeks and has responded poorly to an emollient cream. The pruritus is described as ‘intense’ and has resulted in him having trouble sleeping. On inspecting the skin you notice a combination of papules and vesicles on his buttocks and the extensor aspect of the knees and elbows. What is the most likely diagnosis?
Dermatitis herpetiformis
Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
A 79-year-old woman presents with an itchy, blistering rash. Examination of her mouth is unremarkable.
Bullous pemphigoid
Blisters/bullae
- no mucosal involvement (in exams at least*): bullous pemphigoid
- mucosal involvement: pemphigus vulgaris
What is Wegeners?
It is an autoimmune condition associated with necrotizing granulomatous vasculitis, affecting both the upper and lower respiratory tract as well as the kidneys.
Granulomatosis with polyangiitis is now the preferred term for Wegener’s granulomatosis.
A 30-year-old man presents with a two-week history of a productive cough.
Whilst examining him you notice a large number of atypical naevi over his torso.
On his back you count between 20-25 moles. He reports no change in any of his moles, no bleeding and no itch.
One particular mole is noted due to the irregular border. It is 6 * 4 mm in size.
This is very likely to be a melanoma and the patient should be fast-tracked to dermatology.
Due to the location and the number of moles he has it is unlikely that he would have noticed any change
A 52-year-old Afro-Caribbean woman presents to the dermatology department.
She has noticed a patch of pigmented skin on her toe, which has been slowly enlarging over the past five months.
On examination, she has pigmentation of the nail bed of her great toe, affecting the adjacent cuticle and proximal nail fold.
Which subtype of melanoma would you expect to present in this manner?
Acral lentiginous melanoma: Pigmentation of nail bed affecting proximal nail fold suggests melanoma (Hutchinson’s sign)
A 35-year-old male presents with the rash shown below, which has been over the past 2 months.
It is intensely itchy.
This patient has an itchy rash that most closely resembles dermatitis herpetiformis. Dermatitis herpetiformis is most commonly caused by coeliac disease; therefore, is treated with a gluten-free diet.
A 40-year-old woman visits the GP with a two-month history of unintentional weight loss. She reports feeling more fatigued than usual but otherwise has no localising signs or symptoms. On examination, hyperpigmentation and thickening of the skin in her groin and axilla are noted; the patient believes this has also been present for approximately 2 months.
Which malignancy is most associated with this presentation?
The most common malignancy associated with acanthosis nigricans
is gastrointestinal adenocarcinoma
A 48-year-old male presents after a month after a holiday to Morocco with a burn across his cheeks and nose which he says is not getting any better. He says that he wore sun-screen on holiday and does not usually get sun-burnt.
On examination there is a uniform area of erythema across the bridge of his nose and extending across his cheeks. Upon this erythema you note there are about a dozen small pustules and papules. Lastly, you note the presence of superficial telangiectasia across the bridge of the nose and a small amount around the labia of the nose.
What treatment is indicated here?
Acne rosacea treatment:
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline
What is the most likely diagnosis?
Plaque psoriasis
the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
A 34-year-old man who is known to have HIV presents with a non-itchy skin eruption on his lower abdomen. He feels otherwise well and has had no similar ‘rashes’ previously.
Molluscum contagiosum is a common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.
Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels.
The majority of cases occur in children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years.
What is the diagnosis?
Which medication is contraindicated?
Perioral dermatitis can be made worse by topical steroids
A 63-year-old gentleman presents to his general practitioner.
He has recently been diagnosed with melanoma after being referred to the dermatologist with a suspicious red lump on his face.
He is awaiting further imaging to see if the melanoma has metastasised.
After being told his subtype of melanoma, he researched further online.
He is now very concerned as he has read that his subtype is the most aggressive subtype and that it metastasises early. Which subtype of melanoma is he likely to have?
Nodular melanoma: Invade aggressively and metastasise early
- Sun exposed skin, middle-aged people
- Red or black lump or lump which bleeds or oozes
- Second commonest
A 42-year-old man is reviewed by his dermatologist for ongoing psoriasis. He was diagnosed several years ago and has had recurrent bouts since then. Recently, he has just completed a 4-week course of topical betamethasone and calcipotriol to bring the latest flare-up under control.
Given the frequency of flare-ups, the dermatologist suggests starting a long-term regime to keep his psoriasis under control.
Which of the following would be suitable long-term?
Calcipotriol may be used on a long-term basis for psoriasis
Most important factor affecting rognosis of melanoma
The invasion depth of a tumour (Breslow depth) is the single most important factor in determining prognosis of patients with malignant melanoma
A 47-year-old woman is brought into the Emergency Department with an erythematous rash that has come on over the last 2 days. On examination, the rash covers an extensive area of her body and has a red, ‘scalded’ appearance. She has ulcerations in her mouth. She looks very unwell and her temperature is 38.2ºC.
She is currently too unwell to give a good history, but her brother is with her and gives you her current medications from her bag.
Given the likely diagnosis, what medication is the most likely cause?
Toxic epidermal necrolysis is a rare but important side effect of which to be aware of penicillins
This woman has toxic epidermal necrolysis (TEN). Over 100 drugs have been noted as causes of TEN/Steven Johnson syndrome,
but the ones that most commonly cause it include penicillins, quinolones, sulfonamides, corticosteroids and NSAIDs.
A 7-year-old girl is admitted to the emergency department with several partial thickness burns on her left foreman, abdomen and right thigh.
She is stable. Analgesia is given, and the wounds are cleaned and dressed.
What is the most accurate way to asses the percentage body surface area affected of the girl?
Lund and Browder chart is the most accurate way to asses the burns area
A 41-year-old woman requests a repeat prescription for citalopram. She also mentions she is constantly itchy and bruises easily. On examination she has reddened palms and a distended abdomen
Iron deficiency anaemia
Different types of melanoma
(4)
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
A 29-year-old man presents with a rash on his trunk. Around two weeks ago he describes developing a patch of ‘eczema’ on his torso the size of 50 pence piece. Around a week later a number of smaller, red patches started to appear as well:
He feels systemically well and has no history of note. What is the most likely diagnosis?
The earlier lesion represents a classical herald patch. Guttate psoriasis is generally has a more homogenic, ‘teardrop’ appearance with a more pronounced scale. This image demonstrates the ‘fir tree’ appearance often seen in patients with pityriasis rosea.
A woman who is 24 weeks pregnant presents with a rash:
- Pemphigoid gestationis
- The blistering lesions are clearly visible on this image
A 52-year-old man asks you to look at the side of his tongue. The white patches have been present for the past few months and are asymptomatic. He is a smoker who is known to have type 2 diabetes mellitus.
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
What is excoriation?
Skin picking
A 43-year-old lady presents to the dermatology department with an evolving lesion on her right lower leg.
She first noticed the lesion 4 months ago, and it has increased in size and changed in colour during this time.
On examination, she has a 2cm by 1.5 cm asymmetrical pigmented lesion, comprised of several shades of brown.
She has Fitzpatrick skin type II and uses sunbeds approximately every 4 months. What is this lesion most likely to be?
Superficial spreading melanoma: Most common type of melanoma that has the typical diagnostic features of a changing mole
You are seeing a 32 week pregnant woman in the GP surgery. She has widespread rash on her body with periumbilical sparing.
What is the most likely diagnosis?
One of the main clinical features of polymorphic eruption in pregnancy is periumbilical sparing
What is Bowen’s disease
Bowen’s disease is a type of precancerous dermatosis that is a precursor to squamous cell carcinoma.
It is more common in elderly patients.
There is around a 5-10% chance of developing invasive skin cancer if left untreated.
You review a 24-year-old man who has recently presented with large psoriatic plaques on his elbows and knees. He has no history of skin problems although his mother has psoriasis. You recommend that he uses an emollient to help control the scaling. What is the most appropriate further prescription to use as a first-line treatment on his plaques?
Topical steroid + topical calcipotriol
Venous ulceration is most characteristically seen above the:
Medial malleolus
An 11-year-old girl is brought to the Emergency Department by her parents after the sudden appearance of widespread blistering, sore mouth and skin tenderness. She also has a three-day history of high fevers and malaise. She has no past medical history except amoxicillin for an ear infection two weeks ago.
She appears systemically unwell with a temperature 39.2ºC, heart rate 187 bpm, blood pressure 100/54 mmHg, respiratory rate 22 /min and SpO2 98%.
On examination, there are widespread erythematous bullae and vesicles covering almost half the body surface. Lesions are also present on the oral mucosa and beginning to affect the eyes. Nikolsky’s sign is positive.
What is the most likely diagnosis?
Toxic epidermal necrolysis is a rare but important side effect of which to be aware of penicillins
A 56-year-old gentleman presents to the dermatology clinic. Over the last few weeks, he has noticed a new, enlarging lesion on his cheek which sometimes bleeds. On examination, he has Fitzpatrick skin type I, multiple melanocytic naevi over his body, and the lesion in question is a large, black, dome-shaped lump, of 1cm diameter, located on his right cheek. What is this lesion most likely to represent?
Nodular melanoma: Red or black lump, oozes or bleeds, sun-exposed skin
A 25-year-old woman presents to her GP with chronic shortness of breath. She occasionally coughs up small quantities of blood and small quantities of clear sputum.
She has no chest pain and denies feeling feverish.
On examination, her heart rate is 70/min, respiratory rate 20/min, sats 93%, blood pressure 120/80mmHg and temperature 36.8ºC.
There are a number of very small telangiectases on the lips.
Which of the following symptoms is she most likely to have experienced?
Hereditary haemorrhagic telangiectasia: can cause pulmonary, hepatic, cerebral and spinal AVMs
Epistaxis
A 4-year-old girl is brought to surgery by her mother who has noticed a number of small ‘spots’ and ‘bruises’ on her legs that have developed over the past 2-3 days. She initially thought this was due to an allergy but it has not gone away. Her daughter is described as being well apart from a cough she’s had for the past 2 weeks.
On examination, she is apyrexial with a heart rate of 96/min. Examination of her ears, throat and chest is normal. There is no neck stiffness or abdominal masses. A number of petechiae are seen around her chest area as well as purpura on her lower legs and arms.
What is the most appropriate action?
Children with new-onset purpura should be referred immediately for investigations to exclude ALL and meningococcal disease
A 78-year-old man presents to the GP with a very painful ulcer on his leg, which began as a tender, raised nodule some time before.
On examination, the GP notes a large ulcer on the calf, which has an overhanging blue edge and a purulent appearance on its surface.
It is exquisitely tender to gentle palpation.
He has had several episodes of illness over the last few months. He has also noticed some weight loss, and that his dentures no longer fit as his gums are swollen. His wife agrees that her husband has been looking pale and ‘under the weather’ for about a month, and is eating less at mealtimes.
Pyoderma gangrenosum is associated not only with IBD and RA but also with myeloproliferative disorders and AML
A 32-year-old female enters the clinic with a 3-week history of a mild rash on her face. She explains how it is very sensitive to the sunlight and has been wearing hats for protection. She is two months postpartum and has no past medical history of note.
On examination, there is an erythematous rash with superficial pustules affecting the forehead, nose and cheeks.
Which of the following would best treat the underlying condition?
Acne rosacea features:
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules
A 21-year-old female has been suffering from well demarcated red, scaly lesions on her elbow and knees for the past few years. She is treated for her condition with corticosteroids and vitamin D.
What is the condition?
Which of the following drugs would most likely exacerbate her underlying condition?
plaque psoriasis
A 47-year-old man presents to the general practitioner with a 6-month history of a chronic erythematous rash of the central face associated with papules.
The rash is aggravated by sun exposure.
He has a past medical history of gastro-oesophageal reflux disease, no allergies and has never sought medical assistance for this condition before.
Which management option would be considered first-line in this patient?
Acne rosacea treatment:
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline
You are working in general practice and see a 24-year-old male with a likely diagnosis of pityriasis rosea. What most commonly precedes this condition?
Pityriasis rosea often follows a viral infection
A 62-year-old man presents with a lesion on the right side of his nose. He is unsure how long it has been there.
The rolled, pearly edges with telangiectasia surrounding a central crater make basal cell carcinoma the most likely diagnosis.
A 27-year-old man comes to see you as he has just returned from a beach holiday in Turkey and has noticed pale white patches on his neck and back. They are circular in shape and slightly itchy.
Which one of the following is the most likely diagnosis?
Pityriasis versicolor is a superficial cutaneous fungal infection caused by Malassezia furfur which usually presents on the trunk or back and is scaly is appearance.
A 3-year-old girl is taken to the GP due to a rash on her upper arm. On examination multiple raised lesions of about 2 mm in diameter are seen. On close inspection a central dimple is present in the majority of lesions.
What is the likely diagnosis?
Molluscum contagiosum is a common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.
A 60-year-old man asks you to have a look at a ‘sore’ on his right ear.
It has been present for around 6 months and is not painful. What is the most likely diagnosis?
Actinic keratoses
- small, crusty or scaly, lesions
- may be pink, red, brown or the same colour as the skin
- typically on sun-exposed areas e.g. temples of head
- multiple lesions may be present
The parents of an 8-year-old girl have noticed a small growth on the sole of her foot for the last 3 months that has become painful. On examination, there is a small, firm, hyperkeratotic growth with tiny overlying black dots.
The correct answer is: Salicylic acid
This child has a plantar wart, also known as a verruca. The tiny black dots are caused by thrombosed capillaries. They often self-resolve, but if treatment is desired, topical salicylic acid (15–50%) applied daily for up to 12 weeks can be tried.
A 67-year-old man presents in general practice with a new itchy rash that he has had for a ‘couple of weeks’.
On examination, the rash is purple, raised, and has fine white lines on the surface.
Inside the mouth, the patient has white striae on the oral mucosa which you identify as Wickham striae.
Given the likely diagnosis, what medication is the first-line management for this?
Potent topical steroids are the first-line treatment for lichen planus
A 19-year-old female who has just started work as a cleaner presents with a rash on her hands.
On examination there is a generalised erythematous rash on the dorsum of both hands.
There is no evidence of scaling or vesicles. What is the most likely diagnosis?
The strong alkalis and acids found in cleaning solutions are common triggers of irritant contact dermatitis
A 23-year-old woman presents to the general practitioner with a worsening rash on her face and upper back which is causing a significant impact on her self confidence. She is currently five months pregnant and describes experiencing similar lesions during her teenage years. She is otherwise well with no allergies. The rash has not responded to topical benzoyl peroxide.
Examination identifies numerous erythematous papules and pustules distributed across the patient’s face and upper back.
Which of the following management options is most appropriate?
Acne vulgaris in pregnancy - use oral erythromycin if treatment needed
An 84-year-old woman with a history of ischaemic heart disease is reviewed in a nursing home.
She has developed tense blistering lesions on her legs.
Each lesion is around 1 to 3 cm in diameter and she reports that they are slightly pruritic.
Examination of her mouth and vulva is unremarkable. What is the most likely diagnosis?
Blisters/bullae
no mucosal involvement (in exams at least*): bullous pemphigoid
mucosal involvement: pemphigus vulgaris
A 40-year-old man complains of widespread pruritus for the past two weeks. The itching is particularly bad at night. He has no history of note and works in the local car factory. On examination he has noted to have a number of linear erythematous lesions in between his fingers. What is the most likely diagnosis?
Scabies
A 54-year-old lady attends with a rash.
She describes a facial rash present for several weeks associated with flushing.
On examination, there is erythematous papulopustular rash with telangiectasia across both cheeks and nose.
Given the likely diagnosis, which associated complication may she also have?
Acne rosacea
- chronic skin condition which causes persistent facial flushing, erythema, telangiectasia, pustules, papules and rhinophyma
- It can also affect the eyes causing blepharitis, keratitis, conjunctivitis
- It is treated with topical antibiotics e.g. metronidazole gel or oral tetracycline (especially if ocular symptoms).
A 29-year-old woman who is 24 weeks pregnant presents to the antenatal clinic with a worsening rash on her legs. She had initially noticed multiple small red rounded lumps on both her lower legs. The lesions initially measured 3cm in diameter and have been slowly growing in size over the past two weeks. The lesions now range between 6-9cm nodules on both her shins which were becoming painful. This is her second pregnancy and she denied experiencing a similar rash before.
What is the likely cause for the rash in this case?
Erythema nodosum may be caused by pregnancy
A 30-year-old male develops an intensely itchy rash over his shins and knees over a course of 3 months.
He has also noticed some weight loss recently but reports no other symptoms.
This patient has characteristic dermatitis herpetiformis.
This is characterised by intense itchy bumps and blisters in a rash-like form.
This condition is closely related to coeliac disease, a potential cause of this patient’s weight loss.
Dermatitis herpetiformis rash is diagnosed by skin biopsy which shows a granular pattern of IgA deposition.
A 58-year-old woman presents with facial redness. This has been worsening since her holiday to Spain but she is otherwise asymptomatic.
She has a background of hypertension and takes amlodipine 5mg OD. She has no allergies and has not started any new medications recently.
On examination, telangiectasia are present with papules and pustules clustered around her nose and cheeks. She is afebrile.
What is the most likely diagnosis?
Acne rosacea features:
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules
Features of guttate psoriasis
(3)
- Classically preceded by a streptococcal sore throat 2-4 weeks
- ‘Tear drop’, scaly papules on the trunk and limbs
- Most cases resolve spontaneously within 2-3 months
Features of BCC
(3)
- sun-exposed sites, especially the head and neck account for the majority of lesions
- initially a pearly, flesh-coloured papule with telangiectasia
- may later ulcerate leaving a central ‘crater’
Basal cell carcinoma (BCC) is one of the three main types of skin cancer. Lesions are also known as rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare.
BCC is the most common type of cancer in the Western world.
What is the most common malignancy associated with acanthosis nigricans?
The most common malignancy associated with acanthosis nigricans
is gastrointestinal adenocarcinoma
A 32-year-old man is involved in a house fire and sustains extensive partial thickness burns to his torso and thigh.
Two weeks post operatively he develops oedema of both lower legs. The most likely cause of this is:
Loss of plasma proteins is the most common cause of oedema developing in this time frame.
A 72 year-old woman presents to the GP with an itchy, sore white plaque on her vulva.
The patient has a past medical history of type 1 diabetes and no personal or family history of cancer.
What is the most likely diagnosis?
This patient has the characteristic description of lichen sclerosus which is more commonly seen in elderly women.
Diagnosis is made on clinical findings.
Lichen sclerosus is associated with other autoimmune conditions and as such the history of type 1 diabetes is relevant.
Management
- topical steroids and emollients
A 68-year-old Caucasian man presents with a lesion on his scalp for the last 6 weeks. It has gradually increased in size and is associated with discomfort and some bleeding.
He has a history of a renal transplant 10 years ago, type 2 diabetes mellitus and hypertension. There is no family history of skin cancer.
On examination, there is a non-pigmented indurated plaque on the scalp with surrounding inflammation.
What is the most likely diagnosis?
Renal transplant patients - skin cancer (particularly squamous cell) is the most common malignancy secondary to immunosuppression
A 72-year-old man presents with a large nodule on his face. It is friable. There is no regional lymphadenopathy. He is lost to follow up and re-attends several months later. On this occasion the lesion has been noted to resolve with scarring.
The correct answer is: Keratoacanthoma
Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.
A 76-year-old man has a longstanding patch of rough, itchy skin on his scalp which has not changed in size. On examination, there is a 1cm area of erythema and some scaling which is rough in texture, with evidence of surrounding sun damage. There is no ulceration or bleeding.
The correct answer is: Diclofenac
This man likely has an actinic keratosis, a common hyperkeratotic lesion that arises on areas of skin that have had long-term cumulative sun exposure. There are no features to suggest that it has transformed into a squamous cell carcinoma.
There are a variety of topical treatments, of which diclofenac is the only available option from the list above. Alternatives include 5-fluorouracil and imiquimod.
You are working in general practice and see a 17-year-old girl with a 8-day history of a lesion on her lower torso.
This is a single 3cm oval plaque, pink in colour, with a scale trailing just inside the edge of the lesion.
She has then had a subsequent 2-day history of generalised, non-pruritic, rash down her torso.
This rash consists of lots of fine scales patches and plaques which follow the pattern of langer’s lines.
What is the most likely diagnosis?
Pityriasis can initially present with a herald patch
A 39-year-old woman presents to her GP with a history of painful fingers and ankles. These symptoms have come on steadily and she didn’t want to come to the GP, but now is worried as her left ring finger has become swollen ‘like a sausage’ and is very painful.
She otherwise feels well. Past medical history includes polycystic ovarian syndrome, psoriasis, depression and a previous excision of a Wilms’ tumour as a child.
On examination of her hands, she has tender swellings at the distal interphalangeal joints. Her left ring finger is diffuse swollen downs it length and is tender to touch.
Given the most likely diagnosis, which of the following is most likely to be present?
The vast majority of patients with psoriatic arthropathy will have nail changes such as onycholysis
A 54-year-old man presents with a lesion on his forearm. This has been slowly developing over the past 2-3 months and has bled on one occasion.
His past medical history includes Alport syndrome for which he had a renal transplant ten years ago.
He currently takes ciclosporin as immunosuppression. He also takes ramipril and amlodipine for hypertension.
The lesion is shown below:
The clue here is immunosuppression.
Patients on ciclosporin and other immunosuppressants have a much higher risk of squamous cell carcinoma.
A 25-year-old man presents with a widespread rash over his body. The torso and limbs are covered with multiple erythematous lesions less than 1 cm in diameter which in parts are covered by a fine scale. You note that two weeks earlier he was seen with a sore throat when it was noted that he had exudative tonsillitis. Other than a history of asthma he is normally fit and well. What is the most likely diagnosis?
Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
Features
tear drop papules on the trunk and limbs
A 22-year-old man presents to the GP with a mass on his lower back.
On examination, there is a 6cm mobile rubbery mass on his lower back just lateral and superior to the sacrum.
The mass is not painful and there are no accompanying symptoms.
Which of the following is the next best step in the management of this patient?
What is the most likely diagnosis?
lipoma
Ultrasound is not neccesary in a lipoma diagnosis unless > 5cm
A 72-year-old man is investigated for weight loss. On examination he is deeply jaundiced and cachectic. He also has a dark velvety lesion coating his tongue.
The correct answer is: Acanthosis nigricans
Acanthosis nigricans may be associated with GI malignancies such as gastric and pancreatic cancer.
A 62-year-old man asks you to look at a lesion on his face:
Keratoacanthoma is a benign epithelial tumour. They are more common with advancing age and rare in young people.
Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
This 17-year-old man has a history of asthma and eczema but is normally fit and well. Yesterday he developed a rash on face which extends down to his torso. He feels generally unwell with flu-like symptoms.
Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2.
A 59-year-old patient presents to dermatology outpatients clinic with a three-month history of discolouration of the skin on his back. On examination, there are patchy areas of mild hypopigmentation covering large areas of the back.
You suspect a diagnosis of pityriasis versicolor. What is the likely causative organism?
Pityriasis versicolor is caused by Malassezia furfur
A 23-year-old woman is seen in the dermatology clinic with a 3-month history of an intensely itchy rash over her hands and feet. She has been working as a veterinarian’s assistant for the last 9 months and there is no clear trigger for her symptoms. She finds the itching is exacerbated on hot days, particularly during her holiday to Spain 4 weeks ago. There is no past medical history of note and she has no known allergies. There is a family history of atopic eczema.
On examination, she has sweaty palms. There is a vesicular rash over her plantar and palmar surfaces. The surrounding skin is erythematous.
What is the most likely diagnosis?
Pompholyx eczema is a subtype of eczema characterised by an intensely pruritic rash on the palms and soles
A 33-year-old patient comes to see you as she has noticed an itchy rash on both elbows. It has been worsening for the past week. On examination, you see a multiple polygonal, flat-topped papular lesions that each measure 5mm diameter on the flexural surface of her elbows, bilaterally. She has no other rash on the rest of her body.
Which one of the following is the most likely diagnosis?
Lichen planus is an itchy, papular rash which most commonly occurs on the palms, soles, genitalia and flexor surfaces of the arms.
A 15-year-old female presents to ambulatory care with a painful pruritic rash that has rapidly worsened over the last 10 hours. Her past medical history includes atopic dermatitis treated with emollients and hayfever.
On examination, she has a monomorphic rash with punched out erosions over her cheeks and bilateral dorsal wrists.
Which of the following is the most likely implicated pathogen?
She should be admitted for IV antivirals and observation.
HSV, Eczema herpeticum
A 52-year-old woman presents with pruritus and lethargy. She has recently put on weight and is complaining about dry skin
Hypothyroidism
Features of allergic contact dermatitis
(4)
- type IV hypersensitivity reaction.
- Uncommon - often seen on the head following hair dyes.
- Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself.
- Topical treatment with a potent steroid is indicated
You are on the morning ward round with your consultant on the labour ward. You come across a patient who has just given birth to a healthy baby boy. You notice several excoriated nodules on her face and neck.
What is the likely cause of the presented dermatosis?
The most common dermatosis in pregnancy is atopic eruption of pregnancy
During a 6-week baby check, you notice a flat, 30x20mm, pink-coloured, vascular skin lesion over the nape of the baby’s neck, which blanches on pressure. On further questioning, this area has been present since birth and has not changed significantly. They are developing normally.
What is the most likely underlying diagnosis?
Salmon patches are a vascular birthmark which usually self resolve
A 4-year-old boy develops multiple tear-drop papules on his trunk and limbs.
He is otherwise well.
What is the most likely diagnosis?
What is the most appropriate management?
guttate psoriasis
guttate - ressembling drops
Reassurance + topical treatment if lesions are symptomatic
A 32 year-old builder presents with sore and itchy skin on his hands and wrists.
He has noticed it gets better when he is not in work and wonders if it is something he is coming into contact with at work causing the irritation.
Which of the following tests could best further investigate this theory?
Contact dermatitis
Features of squamous cell carcinoma
Chronic exposure to ultraviolet rays is the most important risk factor. It can appear as thick, rough, scaly patches that may crust or bleed.
They can also resemble warts or open sores that don’t completely heal.
This description does not match the patient’s presentation, additionally, the fact that in the beginning, it appeared as a pearly, flesh-coloured papule with telangiectasia, point more towards a basal cell carcinoma.
An 8-year-old boy is brought to the GP by his father following a 2-week history of persistent itch.
On examination, you note that the child is scratching his wrists, and you can see linear burrows present on the flexor aspects of his left wrist.
Given the likely diagnosis, what is the most appropriate first-line treatment?
Permethrin is the treatment of choice for scabies
These skin lesions have been present for the past year. What is the most likely diagnosis?
Actinic keratoses
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
A 61-year-old man presents with pruritus. He has had recurrent episodes of painful swelling in the MTP joints and a history of peptic ulcer disease. On examination he has a ‘ruddy’ complexion
Polycythaemia
Features of Pityriasis rosea
- Many patients report recent respiratory tract infections but this is not common in questions
- Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.
- May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
- Self-limiting, resolves after around 6 weeks
A 75-year-old man presents with a ‘sore’ on his lip. This has been present for around four months and has been getting slowly worse. His past medical history includes ischaemic heart disease and chronic obstructive pulmonary disease. He still smokes around 20 cigarettes per day
Squamous cell carcinoma
Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients.
An 82-year-old patient attends her GP surgery due to a rash that has developed over her anterior thighs in the past 3 weeks. She states that it is not painful or itchy but she is concerned as it does not blanch with the application of the ‘glass test’. She states that she has had some flu-like symptoms recently so has spent much of her time in her chair under many blankets and with a hot water bottle on her lap.
On examination, you notice that the patient has a well-demarcated area of mottled erythema which appears net-like across her anterior thighs. The area is non-tender and non-blanching.
What is the most likely diagnosis of this lesion?
Erythema ab igne is caused by infrared radiation and is commonly associated with hot water bottles or open fires
A 2-year-old girl develops a rash on her legs. The next day she is brought to surgery, by which time the rash has spread to the rest of her body.
The classic ‘target’ lesions of erythema multiforme can be seen clearly on this image.
Clinical features of hidradenitis suppurativa
- Initial manifestation involves recurrent, painful, and inflamed nodules.
- HS occurs most commonly on intertriginous skin. The axilla is the most common site
- The nodules may rupture, discharging purulent, malodorous material.
- Coalescence of nodules can result in plaques, sinus tracts and ‘rope-like’ scarring.
An 85-year-old lady presents to her GP 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?
Lichen sclerosus: itchy white spots typically seen on the vulva of elderly women
A 18-year-old female has presented with pustule and nodules in her neck and axillae with a narrow tract visible in the skin. She has noted that they can become swollen, painful and have a small amount of yellow discharge at times.
Given the presentation, what is the most likely diagnosis?
Hidradenitis suppurativa is a chronic, painful, inflammatory skin disorder is characterized by nodules, pustules, sinus tracts, and scars in intertriginous areas
A 5-year-old boy is brought to the surgery by his mother.
She is worried about her son who has been unwell the past 2 days with a fever and general malaise. She has also noticed a rash on his face.
On examination you note multiple yellow-crusted lesions on his cheeks.
His mother comments that these began as small red spots. His temperature is 38.6ºC.
All other examinations are normal.
What is the most likely diagnosis?
Impetigo is a reasonable common condition in young children and is very infectious. The classical clinical features are yellow crusted lesions in the affected area (usually around the mouth), that begin as red macules.
A 8-year-old boy attends the GP surgery with his mother. He recently injured his shin playing football and his mother is concerned it may be infected.
The initial injury was 2 weeks previously and described as a graze.
On examination you see a well healed superficial abrasion on the skin, with multiple small, raised pink papules with a central dimple around the graze.
The skin is otherwise not flushed and cool to touch around the wound. You also notice a crop of similar lesions on his stomach. His mother says these lesions have been present for about 6 months.
What is the likely diagnosis?
Koebner phenomenon can cause molluscum contagiosum lesions to appear at areas of injury
A 53-year-old woman presents to the general practitioner with a 1-year history of worsening erythematous rash on the nose, forehead and cheeks associated with telangiectasia and papules.
The rash is aggravated by sun exposure and hot and spicy food. She has previously sought medical help for this condition before, and despite treatment with topical metronidazole, her symptoms remain uncontrolled. She is otherwise well with no allergies.
Which of the following management options would be most appropriate for this patient?
Acne rosacea treatment:
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline
A 5-year-old child presents with his mother to his GP. His mum is concerned as she has noticed some skin changes which started last week. The lesions are itchy but not painful. There is no past medical history of note except asthma.
On examination, you see the following skin lesion behind the child’s knee:
This child has molluscum contagiosum.
This skin condition is caused by a pox virus and can be identified by its raised, pearly white, and umbilicated lesions.
Supportive care is the mainstay of treatment for this condition, although specialist treatment may be required if the patient is immunocompromised.
This condition normally clears up on its own within 18 months.
Time off school is not necessary but, as the condition is infectious, it is advised to avoid sharing baths, towels, or clothing with others to prevent transmission.
You are the GP reviewing an 81-year-old man with varicose veins.
When he removes his right sock, you notice an ill-defined area of ulceration in the region of the medial malleolus.
There is also pedal oedema to the mid-shins and some cutaneous changes of chronic venous insufficiency.
Pulses are present. You decide to refer to vascular surgery.
Alongside surgery for his varicose veins, which treatment would be most appropriate?
Management of venous ulceration - compression bandaging
Charing Cross 4-layer compression bandaging is the most appropriate initial treatment for venous ulcers - although without surgery for the underlying varicose veins the ulcers are likely to either fail to heal or recur.
A 34-year-old man presents with a three week history of an intensely itchy rash just below his knees. On examination he has a symmetrical vesicular rash as shown below and also some early lesions on the back of his arms.
Dermatitis herpetiformis is an autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
A 55-year-old man presents with the following lesions on his forearm. He complains that they itch and has tried over the counter creams without any success. The patient is worried and would like to know how this condition can be treated.
This patient has purple, polygonal, pruritic papules which are consistent with lichen planus.
A 69-year-old woman asks you to have a look at her feet. She lives out in Spain most of the year but comes back to the UK periodically to see her family.
Actinic keratoses
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
Release of epidermal toxins A and B is seen in which skin condition?
staphylococcal scalded skin syndrome (SSSS)
This is far more common in children and causes a widespread blistering rash
Please look at this skin lesion below a patient’s eye:
spider naevi
A 59-year-old man presents to the GP practice with his wife due to recent changes in his bowel habits.
He reports that his stools have become very loose. He also mentions that he is losing some hair and on examination, the doctor notes numerous red rashes on the skin.
The man is unable to recall when these rashes first appeared.
He is currently taking rifampicin, isoniazid and pyrazinamide for a recent tuberculosis infection.
Isoniazid, an anti-TB medication, may induce pellagra
A 67-year-old man who is a retired builder presents following the development of a number of red, scaly lesions on his forehead. These were initially small and flat but are now erythematous and rough to touch.
Actinic keratoses
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
Characteristics of scabies (4)
The scabies mite burrows into the skin, laying its eggs in the stratum corneum.
The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.
Features
- widespread pruritus
- linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
- in infants, the face and scalp may also be affected
- secondary features are seen due to scratching: excoriation, infection
Toby first presented 6 months ago when his mother was concerned about a birthmark on his face. Examination at the time noted that the birthmark was macular, red in colour and had a poorly defined border. On repeat examination today, the birthmark appears to have resolved.
What is the most likely diagnosis for Toby’s birthmark?
Salmon patches are a vascular birthmark which usually self resolve
Salmon patches are congenital capillary malformations seen at birth. They are often small, flat patches of pink or red skin with poorly defined borders. These tend to resolve by 18 months of age.
A 62-year-old male is referred to dermatology by his GP due to a lesion over his shin. On examination shiny, painless areas of yellow skin over the shin are found with abundant telangiectasia. What is the most likely diagnosis?
Diabetes, waxy yellow shin lesions - necrobiosis lipoidica diabeticorum
You review a 31-year-old woman who has had Crohn’s disease for the past 12 years.She is currently on infliximab therapy.
Pyoderma gangrenosum
A 40-year-old woman presents with a painful ‘rash’ on her shins:
The likely diagnosis here is erythema nodosum (EN). All these tests may have a place but a chest x-ray is important as it helps exclude sarcoidosis and tuberculosis, two important cause of EN
A 28-year-old female presents with increasing concern about a lesion that has developed over her shin. She has never had any lesions like this before.
Which of the following symptoms/signs would indicate this lesion is likely benign?
What is the diagnosis?
Central dimple on squeezing
This lesion looks characteristic for a dermatofibroma; a benign lesion that is characterised by a central dimple forming when the lesion is squeezed.
This clinical sign would clinically confirm a diagnosis of dermatofibroma.
A 30-year-old female in her third trimester of pregnancy mentions during an antenatal appointment that she has noticed an itchy rash around her umbilicus.
This is her second pregnancy and she had no similar problems in her first pregnancy.
Examination reveals blistering lesions in the peri-umbilical region and on her arms. What is the likely diagnosis?
Pemphigoid gestationis is the correct answer. Polymorphic eruption of pregnancy is not associated with blistering
A 22-year-old woman presents due to hypopigmented skin lesions on her chest and back. She has recently returned from holiday in Spain and has tanned skin. On examination the lesions are slightly scaly. What is the most likely diagnosis?
Pityriasis versicolor
What is the most likely diagnosis?
The patient has guttate psoriasis.
The rash is often widespread on the torso, legs, and arms, often with >100 individual lesions. It can be tear-drop-shaped.
Define telangiectasia
a condition characterized by dilatation of the capillaries causing them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.
A 53-year-old man presents with a nodule on his chin.
He is concerned because it has grown extremely rapidly over the course of the preceding week.
On examination he has a swollen, red, dome shaped lesion with a central defect that contains a keratinous type material.
The correct answer is: Keratoacanthoma
Keratoacanthomas are characterised by a rapid growth phase.
This may mimic amelanotic melanoma (although such rapid growth is rare even in these lesions).
The keratin core is the clue as to the true nature of the lesion.
What is the most likely diagnosis?
Basal cell carcinoma
A 79-year-old female presents to her general practitioner with a lesion on her nose which she first noticed three months ago. She describes that it started as a white patch with some ‘wide red vessels’ around it. She reports no other lesions across her body.
basal cell carcinoma
- un-exposed sites, especially the head and neck account for the majority of lesions
- initially a pearly, flesh-coloured papule with telangiectasia
- may later ulcerate leaving a central ‘crater’
You are examining the back of a 74-year-old man and notice the following:
This man has multiple seborrhoeic keratoses, also known as basal cell papillomas.
You are an FY2 in General Practice reviewing a 72-year-old woman with a background of Parkinson’s disease. She has come in today with a 4-week history of sore, gritty eyes. She reports that both eyes are affected and that the symptoms are worst in the morning.
On examination, she has inflamed skin with fine scaling around the nasolabial folds and eyelashes, and her ear canal is erythematous and obscured by debris.
What is the most likely unifying diagnosis?
Otitis externa and blepharitis are common complications of seborrhoeic dermatitis
A 34-year-old gardener presents with a lesion affecting the dorsum of his right hand.
It has been present for the past 10 days and occurred after he had been pruning rose bushes.
On examination he has a raised ulcerated lesion which bleeds easily on contact.
The correct answer is: Pyogenic granuloma
Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.
A 32-year-old man is seen at his GP for an erythematous rash in both axillae and his right groin crease. It is slightly scaly and flat and not itchy.
Which of the following oral antibiotics should be used to treat this man’s condition?
What is the likely diagnosis?
Erythromycin is the oral antibiotic of choice to treat erythrasma
A 34-year-old man with a long history of back pain asks you to have a look at his back. His wife has noticed a rash.
erythema ab igne
A woman who is 31 weeks pregnant presents with a rash on her abdomen and thighs:
The rash is very itchy and she is having difficulty sleeping at night. What is the most likely diagnosis?
Polymorphic eruption of pregnancy
- pruritic condition associated with last trimester
- lesions often first appear in abdominal striae
- management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
A 19-year-old man presents with the following lesions on his leg. They are mildly pruritic.
Two weeks later he develops numerous other lesions on his body. What is the most likely diagnosis?
Pityriasis rosea describes an acute, self-limiting rash which tends to affect young adults. The aetiology is not fully understood but is thought that herpes hominis virus 7 (HHV-7) may play a role.
A 24-year-old male presents with a lesion on the back of his hand. He is concerned that it is due to excessive sun exposure and could be serious. It has not bled and is not itchy. It is pictured below.
Dermatofibroma is conservatively managed with reassurance as it is benign.
A 34-year-old man with a history of polyarthralgia, back pain and diarrhoea is found to have a 3 cm red lesion on his shin which is starting to ulcerate.
What is the most likely diagnosis?
This patient is likely to have ulcerative colitis, which has a known association with large-joint arthritis, sacroilitis and pyoderma gangrenosum
What is the diagnosis?
Seborrhoeic keratosis
Features
large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface
A 30-year-old man is investigated for recurrent nose bleeds and iron deficiency anaemia. You notice a number of erythematous lesions on his skin:
Hereditary haemorrhagic telangiectasia
A 22-year-old woman is troubled by intensely itchy crops of blisters on her arms and legs. On examination she is malnourished and she has papulovesicular eruptions over her elbows and knees.
Dermatitis herpetiformis
Dermatitis herpetiformis is seen in association with coeliac disease.
A 27-year-old man presents as he is feeling generally unwell. Around 5 days ago he started having a sore throat associated with myalgia and lethargy. Yesterday he developed a fever and over the course of the past 24 hours a rash has appeared. His past medical history includes anxiety and atopic eczema. On examination he has a widespread erythematous rash, with many of the lesions having a ‘target’ appearance. Some of the lesions are becoming bullous. His pulse is 120/min and temperature 38.4º. He also has conjunctivitis and some ulceration and sloughing around the mouth:
Erythema multiforme is a hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.
A 43-year-old man presents to his GP with a persistent skin lesion overlying the right second metacarpophalangeal joint:
Granuloma annulare
- papular lesions that are often slightly hyperpigmented and depressed centrally
- typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
A 55-year-old man asks you to have a look at some ‘red spots’ on his torso. They have been present for about the past six months.
Cherry haemangioma
Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries. They are more common with advancing age and affect men and women equally.
A 64-year-old man presents with a ‘rash’ on his legs which has developed over the past few days:
Vasculitis is commonly limited to the skin and may be caused by infections, drugs, autoimmune disorders and malignancy.
A middle aged man develops a non-pruritic rash after starting allopurinol therapy for gout. The rash develop within 24 hours and started on the back of his hands.
Erythema multiforme
A 78-year-old man presents with a lesion on his right cheek. This has slowly been getting larger over the past 6-7 months. He has no history of skin problems and the only past medical history of note is osteoarthritis of the knee and depression.
Squamous cell carcinoma
Don’t be fooled into thinking this is a basal cell carcinoma (BCC) by the presence of telangiectasia near the lesion. With BCC’s these are generally found on the rolled edges of the lesion rather than being scattered around the periphery
The lesion below started as a small red papule which grew in size before starting to ulcerate:
What is the condition?
Wha is it commonly associated with?
Pyoderma gangrenosum
A 64-year-old diabetic patient presents with fevers, fatigue and generally feeling unwell for the past 48 hours. On examination she has a raised well-defined red rash with sharp borders on her legs. It is tender and warm to touch.
Which is the most likely causative organism?
Erysipelas is localised skin infection caused by Streptococcus pyogenes
A 6-year-old boy is brought to his GP by his father with what he describes as ‘red sores’ around the mouth. You decide to prescribe an antibiotic. The father states that the boy is currently otherwise well but suffered with an asthma exacerbation three weeks previously.
Topical hydrogen peroxide did not help for a similar episode previously.
What would be the most appropriate treatment in this case?
What is the diagnosis?
Impetigo - topical fusidic acid if hydrogen peroxide not suitable
A 47-year-old woman complains of an itchy neck and scalp:
Seborrhoeic dermatitis
an inflammatory reaction to Malassezia furfur
A 50-year-old man presents with shiny, flat-topped papules on the palmar aspect of the wrists. He is mainly bothered by the troublesome and persistent itching.
Which condition is suspected?
What is the most appropriate treatment?
Lichan Planus
potent topical steroids are the mainstay of treatment
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
Differences (3) and Similarities (3) between Wegener’s and Churg-Strauss syndrome
A 27-year-old man with a history of depression and coeliac disease presents with an itchy rash on his buttocks:
dermatitis herpetiformis
A 22-year-old male comes to see you the GP. He explains that there are strange spots on his body that he first noticed over 2 months ago.
The spots are slightly itchy and he assumed they would go away without treatment.
He has no past medical history and states he leads an active life with regular exercise.
On examination, there are 6 hypopigmented spots on the left posterior aspect of his neck.
What is the most likely diagnosis?
Pityriasis versicolor presents with hypopigmented patches
Pityriasis versicolour is a fungal infection that characteristically causes light patches on the trunk which can be mildly pruritic.
Bullous pemphigoid
oral corticosteroids
The lesion has been getting bigger for the past few weeks. There is no history of trauma. What is the most likely diagnosis?
Bowen’s disease
Bowen’s disease is a type of precancerous dermatosis that is a precursor to squamous cell carcinoma.
It is more common in elderly patients.
There is around a 5-10% chance of developing invasive skin cancer if left untreated.
A 45-year-old woman presents with itchy, violaceous papules on the flexor aspects of her wrists. She is normally fit and well and has not had a similar rash previously. Given the likely diagnosis, what other feature is she most likely to have?
Lichen
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
