Dermatology

Question 1

Chronic, itchy, blistering, papulo-vesicular blisters - elbows, scalp, shoulders and ankles.

Answer 1

Dermatitis herpetiformis

Seen in patients with gluten sensitive enteropathy - coeliac disease.

Diagnose with a skin biopsy and positive test of coeliac disease with anti-ttp antibodies.

Management: gluten free diet and Dapsone (antibiotic) to reduce itch.

Question 2

Answer 2

Neurofibromatosis

Autosomal dominant genetic disorder causing lesions in the skin, nervous system and skeleton. Type 1 is more common, type 2 has CNS tumours rather than skin lesions.

Diagnosis for type 1: at least 6 cafe au lait spots, axillary or inguinal freckles, neurofibromas etc.

Question 3

Answer 3

Pyoderma gangrenosum

Associated with Crohn’s disease

Painful nodules or pustules break down to leave a progressively enlarging ulcer

Purulent necrotic surface with blue black raised inflamed border

Urgent referral to dermatologist for immunosuppression and wound care

Question 4

Answer 4

Tuberous sclerosis

Autosomal dominant condition characterized by a triad of cutaneous abnormalities, mental retardation, and seizures

The skin lesions are: ash leaf hypopigmentation (usually earliest sign), periungual fibromata (nodules around nails), shagreen patches (normal coloured plaques firm texture), and adenoma sebaceum (raised red papules on face, particularly around nose).

Question 5

Pellagra

Answer 5

Dermatitis, diarrhoea, dementia.

Nicotinic acid (vit B3) deficiency.

Question 6

Answer 6

Arterial ulcer

Punched out appearance, well demarcated, occurs at pressure points of foot, painful. Skin surrounding ulcer is shiny, erythematous and hairless.

Hx of peripheral vascular disease.

Question 7

Answer 7

Venous ulcer

Usually large, shallow, painless, located at the medial malleolus. Hx of DVT. Measure ankle brachial BP.