Dermatology

Question 1

Cutaneous Lupus

Answer 1

Affects women more
20-50 yo

Risk factors
High incidence among family members
Cigarette smoking
Sun exposure
Medications

Localised acute CLE: malar ‘butterfly’ rash – redness and swelling over both cheeks, sparing the nasolabial folds, lasting hours to days
Generalised acute CLE: diffuse or papular erythema of the face, upper limbs (sparing the knuckles), and trunk resembling a morbilliform drug eruption or viral exanthem
Toxic epidermal necrolysis-like acute CLE: is associated with lupus nephritis or cerebritis, and must be distinguished from drug-induced toxic epidermal necrolysis in a patient with SLE.

Question 2

Bowen’s Disease = Squamous cell carcinoma in-situ

Answer 2

Typically on sun-exposed areas (face, lower leg)

Well demarcated, slowly expanding
- scaling plaque, often confused for psoriasis

Usually asymptomatic, can ulcerate

Recurrence of 5-10%

Ix
- Shave or punch biopsy

Rx
- Typically refer for excision as may need photodynamic therapy

If superficial (not extending to hair follicle on biopsy), can use:

• Flurouracil 5% topically daily for 3-4 weeks (can repeat once if not resolving)
• Imiquimod 5% topically at night for 6 weeks (wash off in morning)

DO NOT USE cautery, cryotherapy, laser