Facial Rashes

Question 1

What is chloasma?

What areas are more commonly affected?

Answer 1

Symmetrical pigmentary disorder affecting facial skin of women associated with hormone changes (pregnancy/birth control)

Forehead > cheeks and chin

Question 2

What are some common complications of rosacea?

Answer 2

• Keratitis (inflammation of the cornea)
• Rhinophyma (hyperplasia of nasal sebaceous glands and connective tissue)
• Conjunctivitis (inflammation of the conjuctiva)

Question 3

How is chloasma managed?

Answer 3

Management with sunscreens and camouflage cosmetics

(Improves spontaneously following birth/stopping birth control)

Question 4

Define Nodule

Answer 4

Solid elevation of skin larger than 5 mm in diameter

Similar to papule but larger than 5 mm

Question 5

Define Papule

Answer 5

Small solid elevation of skin < 5 mm in diameter

Question 6

What age and demographic is Rosacea common in?

Answer 6

Mostly Middle aged (but can affect anyone)

Mainly affects caucasian origin (uncommon in people of colour)

Question 7

Describe the clinical appearance of Kaposi sarcoma

What are common sites for these lesions?

Answer 7

Red/purplish macules, papules and nodules anywhere on skin or mucous membranes

Mouth, nose, and throat; lymph nodes; or other organs

Initially small/painless, but can grow to ulcerate and become painful

Question 8

How does eczema herpeticum arise?

Answer 8

Involves dissemination of herpes simplex virus on a background of preexisting eczema

Question 9

What is photodamage and how is it exacerbated?

Answer 9

Extrinsic ageing caused by chronic ultraviolet (UV) radiation exposure

This is exacerabated by smoking and pollutants

Question 10

What are commonly affected nerves in a patient with shingles?

Answer 10

Cranial Nerve V
Cranial Nerve VII
Thoracic spinal nerves

Question 11

What is the most common type of skin cancer in the UK?

Answer 11

Basal cell carcinoma
>75,000 new cases a year

Question 12

What cells are involved in a basal cell carcinoma?

Answer 12

Locally invasive cancer of epidermal basaloid cells

Question 13

What symptoms may you see in a patient preceding (before) eczema herpeticum?

Answer 13

Malaise
Fever
Lymphadenopathy

Question 14

What is Rosacea?

Answer 14

Chronic inflammatory facial dermatosis characterised by erythema and pustules

(almost exclusively confined to face)

Question 15

Define Macule

Answer 15

Localized area of colour or textural change
in skin

Question 16

What are some risk factors of severe eczema herpeticum?

Answer 16

Pregnancy
Immunosuppression

Question 17

What is the presentation of Basal cell carcinoma?

What are the two types?

Answer 17

Spontaneous ulcer that fails to heal
May bleed with crust formation which may separate during sleep to leave blood on pillow

Can be
Nodular BCC - pearly papule with a rolled edge, telangectasia and central depression

Superficial BCC - Slowly growing scaly pink patch or plaque

Question 18

What is Kaposi sarcoma?

(what type of disease?)

Answer 18

A disease of endothelial cells of blood vessels and lymphatic system

Question 19

What are some predisposing factors of SCC/BCC?

Answer 19

• Arsenic ingestion in tonics
• Burn / vaccination scars
• Skin type I or II (freckles)
• UV radiation (sun exposure in childhood)
• Ionizing radiation
• Immunosuppression

Question 20

What is the prognosis of a basal cell carcinoma?

Answer 20

Most BCCs grow slowly and are nonaggressive
If long standing can destroy skin and deep tissues (rodent ulcers)
Only rarely metastasise

Question 21

What is Seborrhoeic dermatitis?

What causes this?

Answer 21

Chronic scaly inflmmatory eruption of face, scalp and eyebrows

Overgrowth of commensal yeast P. ovale implicated

Question 22

What is the clinincal presentation of rosacea?

Answer 22

Facial flushing
Eryhthema and telangectasia with recurrent pustules over areas exposed to light

dilated/broken blood vessels near surface of skin or mucous membranes.

Question 23

How do you manage Seborrhoeic dermatitis?

Answer 23

Scalp - medicated shampoo

Facial lesions - Antimicrobial often combined with 1% hydrocortisone cream

Recurrence is common so treatment may require to be repeated

Question 24

What are the clinical features of Perioral dermatitis?

Answer 24

Small reddish papules with tiny pustules
Spreads around mouth
Clear zone immediately adjacent to vermillion border
Females aged between 15-25 years typically affected

Question 25

What is a severe side effect that could arise from a patient having eczema herpeticum?

Answer 25

Keratoconjunctivitis leading to sight loss

inflammation of the cornea and conjunctiva

Question 26

What gender and age are Basal cell carcinomas more common in?

Answer 26

Male > Female
40+ age

Question 27

What is Eczematous cheilitis?

Answer 27

Inflammation of lips with redness, dryness and scaling

2 major groups:
(i) Endogenous: eg atopic eczema (allergy related)
(ii) Exogenous : eg Lip licking dermatitis or Allergic contact cheilitis

Question 28

What is the link between immunosuppression and Kaposi Sarcoma?

Answer 28

The greater the immunosuppression the more extensive and aggressive Kaposi Sarcoma

Question 29

What is actinic keratosis?

How do you manage this?

Answer 29

Discrete scaly hyperkerartotic lesions found on sun exposed areas of hands face and neck

Treatment: curettage, excision or application of 5-fluorouracil

Can progress to SCC

Question 30

How do you manage a patient with Rosacea? (2)

Answer 30

Topical metronidazole gel twice daily
Oral tetracycline for 2-3 months

Question 31

Why is the role of a GDP important when dealing with the skins?

Answer 31

GDPs likely to see patients more regularly than medical GPs and so have a great opportunity to make an early diagnosis of skin disease involving head and neck

Question 32

What is a risk of patients with opthalmic shingles (opthalmic herpes zoster) and what should you do if a patient presents with that?

Answer 32

Risk - Corneal scarring with result lost of vision

Action - Urgent referral to Ophthalmology