Derm

Question 1

Parkinsons disease is associated with what skin condition?

Answer 1

sebhorrhoeic dermatitis

Question 2

Seborrheoic dermatitis

• what causes it?
• features
• associated conditions
• Tx

Answer 2

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

Features
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

Associated conditions include
HIV
Parkinson’s disease

Scalp disease management
over the counter preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) are first-line
the preferred second-line agent is ketoconazole
selenium sulphide and topical corticosteroid may also be useful

Face and body management
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common

Question 3

Pityriasis versicolor

Answer 3

superficial cutaneous fungal infection caused by Malassezia furfur which usually presents on the trunk or back and is scaly is appearance.

Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

Features
most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

Predisposing factors
occurs in healthy individuals
immunosuppression
malnutrition
Cushing's

Management
topical antifungal. NICE Clinical Knowledge Summaries advise ketoconazole shampoo as this is more cost effective for large areas
if failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole

Question 4

Melasma

Answer 4

dark skin discoloration which usually occurs in pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy.

Question 5

Pityriasis alba

Answer 5

Pityriasis alba is hypopigmentation of the skin which usually occurs in children and young adults. It initially appears as pink scaly patches which later leave pale areas on the skin. This is usually more noticeable on darker skin.

Question 6

what should you do with any transplant patient presenting with a skin lesion?

Answer 6

urgent referral to derm

Question 7

Causes of acanthosis nigricans?

Answer 7

gastrointestinal cancer
diabetes mellitus
obesity
polycystic ovarian syndrome
acromegaly
Cushing's disease
hypothyroidism
familial
Prader-Willi syndrome
drugs: oral contraceptive pill, nicotinic acid