MED: Dermatology Flashcards
Management of acne vulgaris?
1. Topical combination therapy 12w:
- topical adapalene + benzoyl peroxide
- topical tretinoin + clindamycin
- topical benzoyl peroxide + clindamycin
2a. Oral abx (max 3m) + topical BPO /+ adapalene:
- 1st line = tetracyclines (lymecycline, doxycycline)
- 2nd line = macrolides (erythromycin)
2b. COCP + BPO/adapalene
- E.g. Dianette (co-cyprindiol)
3. Dermatologist referral & oral isotretinoin
- Must be on 2 forms of contraception
- SE > dryness, pruritis, conjunctivitis, muscle aches, deranged LFTs
- Associated with low mood and suicidal ideation
What may precipitate guttate psoriasis?
Streptococcal infection 2-4 weeks prior to the lesions appearing
Clinical features of guttate psoriasis?
- Tear drop papules on the trunk and limbs
- Pink, scaly patches or plaques of psoriasis
- Tends to be acute onset over days
Management of guttate psoriasis?
> > Most cases resolve spontaneously within 2-3 months
- Topical agents as per psoriasis
- UVB phototherapy
What is actinic keratoses?
Represent dysplastic epidermal lesions, often considered precursors to cutaneous squamous cell carcinoma (cSCC)
Clinical features of actinic keratoses?
- small, crusty or scaly patches / pustules / 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
Main concern with actinic keratoses?
While some AKs may regress spontaneously, a subset can progress to invasive SCC, necessitating prompt intervention.
Histological findings in actinic keratoses?
Atypical keratinocytes confined to the lower third of the epidermis (corresponding to in-situ SCC when full-thickness)
Management of actinic keratoses?
- Prevention of further risk - sun avoidance, sun cream
- Fluorouracil cream - typically 2-3 week course, skin will become red/inflamed - sometimes topical hydrocortisone given to help settle inflammation
- Topical diclofenac - may be used for mild AKs, moderate efficacy but fewer side-effects
- Topical imiquimod - good efficacy
- Cryotherapy
- Curettage and cautery
Clinical features of BCC?
- Lesions are also known as rodent ulcers and are characterised by slow-growth and local invasion
- Sun-exposed sites - esp head and neck
- Initially a pearly, flesh-coloured papule with telangiectasia
- May later ulcerate leaving a central ‘crater’
Management of BCC?
Referral:
- If BCC is suspected, a routine referral should be made
Management options:
- surgical removal
- curettage
- cryotherapy
- topical cream: imiquimod, fluorouracil
- radiotherapy
Dermatitis herpetiformis?
Chronic, autoimmune, blistering skin disease characterized by intensely itchy papules and vesicles
Association with dermatitis herpetiformis?
Coeliac disease // gluten sensitivity
Clinical features of dermatitis herpetiformis?
- Symmetrical, erythematous, and intensely pruritic papules and vesicles
- Distributed over extensor surfaces - elbows, knees, and buttocks
- Lesions may also appear on scalp, face, and neck
- Scratching often leads to excoriation and crusting
- Periods of exacerbation and remission
Investigations for dermatitis herpetiformis?
- Skin biopsy on perilesional skin for direct immunofluorescence (DIF) microscopy - granular IgA deposits in the dermal papillae
- Histopathology of lesional skin - subepidermal blisters with neutrophilic infiltration in the dermal papillae
- Serologic testing - IgA anti-tTG antibodies (also found in coeliac disease)
- Screening for coeliac disease is recommended
Management of dermatitis herpetiformis?
- Strict, lifelong gluten-free diet - reduction in IgA anti-tTG antibodies, resolution of skin lesions, and prevention of potential complications associated with untreated coeliac disease
- Dapsone - sulfone abx to provide relief of severe pruritus and skin lesions
- Other medications, such as sulfapyridine and colchicine, can be considered in patients who cannot tolerate dapsone
Eczema herpeticum?
Potentially serious primary infection of the skin by herpes simplex virus 1 or 2, which typically affects people with atopic dermatitis or eczema but may also affect those with other inflammatory skin conditions
Clinical features of eczema herpeticum?
> > Rapidly progressing painful rash
- Areas of rapidly worsening, painful eczema
- Vesicular rash
- Blisters may be filled with clear yellow fluid, thick purulent material or blood stained
- Punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3mm that are uniform in appearance (monomorphic)
- Initially form over areas affected by atopic dermatitis but spreads to involve normal skin over 1-2 weeks
- These may coalesce to form larger areas of erosion with crusting
- Typically the lesions will heal over 2-6 weeks
- Possible fever, lethargy, lymphadenopathy or distress
Investigations for eczema herpeticum?
In any cases where eczema herpeticum is suspected:
- Referral to a specialist paediatric dermatologist
- Eczema herpeticum involving the skin around the eyes should be referred for same-day ophthalmology review
Viral infection can be confirmed by viral swabs sent for:
- PCR, viral culture, direct fluorescent antibody stain
If herpetic keratitis is suspected:
- Staining with fluorescein
- A stained dendritic ulcer is diagnostic
Management of eczema herpeticum?
> > Dermatological emergency
Prompt treatment with antiviral medication should eliminate the need for hospital admission:
- (1) Oral aciclovir 5 times daily for 10-14 days
- Alternative: valaciclovir twice daily for 10-14 days
- (2) children / if patient vomiting / unable to take tablets: IV aciclovir
Management of ocular involvement involves:
- Ganciclovir ointment five times daily (3 hourly) for 7-10 days
- Alternatives: trifluridine drops 1 drop nine times daily for 7-10 days followed by dose tapering
- A corneal transplant may be indicated in cases of postherpetic scarring that significantly affects vision
Complications of eczema herpeticum?
Secondary infection (most common):
- Staph aureus might cause impetigo
- Strep may cause cellulitis
Herpetic keratitis:
- Infection of the cornea
- If untreated, can lead to blindness
Organ failure and dissemination:
- Particularly, the brain, lungs and liver
- May result in septic shock, meningitis, encephalitis
Impetigo?
Superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes
Clinical features of impetigo?
- Lesions tend to occur on the face, flexures and limbs not covered by clothing
- ‘Golden’, crusted skin lesions
- Very contagious
Management of impetigo?
Limited, localised disease:
- Hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
- Topical antibiotic creams - fusidic acid (mupirocin if fusidic acid resistance suspected / MRSA)
Extensive disease:
- Oral flucloxacillin
- Oral erythromycin if penicillin-allergic
School exclusion:
- Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
Intertrigo?
Dermatitis that affects a skin fold, for example underneath a breast. It may be non-infective but is commonly complicated by a secondary fungal infection.
Clinical features of intertrigo?
- Erythematous rash on a skin fold
- Skin may become moist and macerated
- Typical sites include underneath the breast fold, in the groin, axilla, between the buttocks
Management of intertrigo?
- General measures - zinc oxide ointment
- Fungal infection - clotrimazole, miconazole
- Erythrasma infection - erythromycin
Keratoacanthoma?
Rapidly growing, self-resolving, low-grade cutaneous tumour
Clinical features of keratoacantoma?
- Rrapidly-growing, dome-shaped cutaneous lesion with a central keratin plug
- Usually solitary
- Evolves over weeks to months, eventually stabilising and sometimes regressing spontaneously
- Hallmark = rapid growth, followed by a plateau phase, and potentially a resolution phase.
- Most commonly found on sun-exposed areas - face, neck, and extremities (may also occur on mucous membranes)
- Sometimes local trauma or scarring is implicated in the lesion’s onset
- Symmetry generally well maintained - ie benign appearance
- Nodule or papule often flesh-coloured to erythematous, surrounded by a wall of inflamed tissue, with a central, keratin-filled crater
- Surface of lesion often smooth, although crust or scale may be present
- May be tender or painful depending on size and location
- Some KAs may present with a superficial ulcerated surface.
- Multiple lesions may be present in syndromic forms such as Ferguson-Smith syndrome or Muir-Torre syndrome.
Management of keratoacanthoma?
- Spontaneous regression within 3 months common, often resulting in a scar
- Such lesions should however be urgently excised as it is difficult clinically to exclude SCC
- Removal also may prevent scarring
Clinical features of molluscum contagiosum?
- Characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter
- Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet)
- Children - commonly seen on trunk and in flexures, but anogenital lesions may also occur
- Adults - sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen
- Rarely, lesions can occur on the oral mucosa and on the eyelids
Management molluscum contagiosum?
Self-care advice:
- Self-limiting condition // spontaneous resolution usually occurs <18 months
- Avoid sharing towels, clothing, and baths with uninfected people
- Avoid scratching lesions - if problematic, consider treatment to alleviate the itch
If lesions are troublesome or considered unsightly, use simple trauma or cryotherapy:
- Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath (limited to a few lesions at one time)
- Cryotherapy may be used in older children or adults
Treatment may be required if:
- Itching is problematic - prescribe an emollient and mild topical corticosteroid (e.g. hydrocortisone 1%)
- Skin looks infected (e.g. oedema, crusting) - prescribe a topical antibiotic (e.g. fusidic acid 2%)
Referral may be necessary in some circumstances:
- HIV-positive + extensive lesions = urgent referral to a HIV specialist
- Eyelid-margin or ocular lesions + associated red eye = urgent referral to an ophthalmologist
- Adults with anogenital lesions = referral to genito-urinary medicine, for screening for other STIs
Periorificial dermatitis?
Inflammatory disorder of the skin which is characterised by the eruption of multiple erythematous papules and pustules around the eyes, nose and mouth
Clinical features of periorificial dermatitis?
> > Most commonly seen in young females
Classical type:
- Clusters of follicular papules and pustules overlying an erythematous base, with or without scaling
- The inflammation is limited only to the skin surrounding the mouth, nose and eyes.
- Around the mouth, the skin of the vermilion border is often spared, this is characteristic of cPOD
- Burning or stinging in the area of the lesions. Itching is rare, but can occur.
- Patients may have noticed rash after using a new medication (e.g. corticosteroids), skincare or cosmetic product
Granulomatous type:
- Rarer variant - typically occurs in prepubescent children, most common of Afro-Caribbean ethnicity
- Flesh coloured or yellow-brown coloured papules or plaques around the mouth, nose and lower eyelids
- Erythema and scaling is less prominent, helping to differentiate this from classical POD
- Biopsy of these lesions will reveal perifollicular granulomatous infiltration
Management of periorificial dermatitis?
> > Benign and self-limiting (many patients reach symptom resolution without intervention)
If symptoms are troublesome / persistent, pharmacological therapy should be initiated
Zero therapy:
- Discontinuing the use of all topical facial products which may have triggered or could have exacerbated POD symptoms:
- Discontinue the use of corticosteroids on the face and encourage patients using them elsewhere on the body to wash their hands thoroughly after application to prevent transfer to the face
- Avoidance of topical skincare/cosmetic products which may irritate the skin
- Once POD has resolved patients can restart topical products slowly and individually to allow the skin to respond to each product and allow the discontinuation of any known POD triggering product
Pharmacological therapies:
Mild POD (lesions covering only a small area):
- Initial therapy: Topical antibiotic cream, such as erythromycin or metronidazole
- Second line therapy: Topical tacrolimus ointment or pimecrolimus cream
Moderate or severe POD (lesions covering large areas of the face) or whose symptoms have not resolved with topical therapy:
- Initial therapy: oral antibiotic therapy, typically with tetracycline, is recommended. This is typically used for 4-8 weeks
- Erythromycin can be substituted for one of the tetracycline’s if they are not well tolerated or contraindicated
Clinical features of pityriasis rosea?
- Usually no prodrome, but minority recent viral infection
- Acute onset of a solitary, oval-shaped herald patch (usually on trunk)
- Followed by smaller, erythematous, oval, scaly patches in a characteristic ‘Christmas tree’ distribution along the Langer’s lines
- Pruritus may be present and can range from mild to severe in intensity
Management of pityriasis rosea?
> > Self-limiting (not contagious and recurrences are rare)
Symptomatic relief:
- Topical corticosteroids - mild-to-moderate potency (e.g., hydrocortisone or clobetasone butyrate) for short-term use (<2 weeks)
- Emollients - regular application
- Oral antihistamines - cetirizine or loratadine
Ultraviolet (UV) therapy:
- In severe or persistent cases
- Narrowband UVB phototherapy may be considered as an adjunct treatment
- Expedites resolution of the rash and provides symptomatic relief
Pityriasis versicolor?
Superficial cutaneous fungal infection caused by Malassezia furfur
Clinical features of pityriasis versicolor?
- 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
Management of pityriasis versicolor?
- Topical antifungal - ketoconazole shampoo
- If failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole
Clinical features of pyoderma gangrenosum?
- Usually starts quite suddenly
- Typically on the lower limb
- Soften at the site of a minor injury (pathergy)
- Small pustule, red bump or blood-blister
- Skin then breaks down resulting in an ulcer which is often painful
- Edge of the ulcer is often described as purple, violaceous and undermined
- Ulcer itself may be deep and necrotic
- May be accompanied by systemic symptoms - fever, myalgia
Management of pyoderma gangrenosum?
> > Potential for rapid progression is high in most patients
- First line = oral steroids
- Other immunosuppressive therapy, e.g., ciclosporin and infliximab, in difficult cases
- Any surgery should be postponed until the disease process is controlled on immunosuppression to risk worsening of the disease (pathergy)
Pyogenic granuloma?
Benign vascular proliferation that commonly manifests as a rapidly growing, friable, erythematous papule or nodule, frequently observed on the skin and mucous membranes
Clinical features of pyogenic granuloma?
- Most common sites are head/neck, upper trunk and hands
- Lesions in the oral mucosa are common in pregnancy
- Initially small red/brown spot
- Rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
- Lesions may bleed profusely or ulcerate
Management of pyogenic granuloma?
- Lesions associated with pregnancy often resolve spontaneously post-partum
- Other lesions usually persist
- Removal methods include curettage and cauterisation, cryotherapy, excision
Rosacea?
Chronic, inflammatory skin condition that primarily affects the face, causing redness, flushing, and visible blood vessels
Classification of rosacea?
- Erythematotelangiectatic rosacea (ETR): Characterized by facial redness, flushing, and visible blood vessels (telangiectasias).
- Papulopustular rosacea: Presents with acne-like breakouts, including papules and pustules, along with facial redness and swelling.
- Phymatous rosacea: Associated with skin thickening, especially around the nose (rhinophyma), and can also affect the chin, forehead, cheeks, and ears.
- Ocular rosacea: Involves the eyes, causing redness, burning, itching, and the sensation of a foreign body. It can lead to complications such as blepharitis, conjunctivitis, and keratitis if not treated promptly.
Clinical features of rosacea?
- Typically affects nose, cheeks and forehead
- Flushing is often first symptom
- Telangiectasia are common
- Later develops into persistent erythema with papules and pustules
- Rhinophyma
- Ocular involvement: blepharitis
- Sunlight may exacerbate symptoms
Management of rosacea?
- Daily application of a high-factor sunscreen
- Predominant erythema/flushing but limited telangiectasia - topical brimonidine gel (used on an ‘as required basis’ to temporarily reduce redness)
- Mild-to-moderate papules and/or pustules - topical ivermectin
- Alternatives include: topical metronidazole or topical azelaic acid
- Moderate-to-severe papules and/or pustules - combination of topical ivermectin + oral doxycycline
Referral should be considered if:
- Symptoms have not improved with optimal management in primary care
- Laser therapy may be appropriate for patients with prominent telangiectasia
- Patients with a rhinophyma
Sacbies?
Caused by the mite Sarcoptes scabiei
Clinical features of scabies?
- widespread pruritus
- linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist - ‘silver lines’
- in infants, the face and scalp may also be affected
- secondary features are seen due to scratching: excoriation, infection
Management of scabies?
- permethrin 5% is first-line
- 2 applications, 1 week apart
- malathion 0.5% is second-line
Guidance:
- avoid close physical contact with others until treatment is complete
- all household and close physical contacts should be treated at the same time, even if asymptomatic
- launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.
Clinical features of seborrhoeic dermatitis in adults?
- Eczematous lesions on the sebum-rich areas - scalp (may cause dandruff), periorbital, auricular and nasolabial folds
- Otitis externa and blepharitis may develop
Management of seborrhoeic dermatitis in adults?
Scalp disease management:
- First-line = ketoconazole 2% shampoo
- OTC preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) if ketoconazole not appropriate or acceptable to the person
- 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
Clinical features of seborrhoeic dermatitis in children?
- Erythematous patches with greasy scales predominantly on sebum-rich areas
- Typically affects the scalp (‘Cradle cap’), nappy area, face and limb flexures.
- Cradle cap is an early sign which may develop in the first few weeks of life - characterised by an erythematous rash with coarse yellow scales
Management of seborrhoeic dermatitis in children?
- Reassurance that it doesn’t affect the baby and usually resolves within a few weeks
- Massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
- If severe/persistent a topical imidazole cream may be tried
Clinical features of Shingles?
Prodrome:
- Acute neuralgia - tingling, burning, itching or occasionally stabbing in nature
- Non-specific symptoms such as malaise, fatigue, headache
- Enlarged lymph nodes in region of affected area
- Typically 2-3 days long, may last up to a week
Infectious phase:
- Rash usually affecting a single dermatome in a band-like distribution
- Unilateral, rarely crossing the midline
- Initially is erythematous and macular in nature
- Progression to erythematous papules, and eventually vesicles or bullae by day 7
- Vesicles become pustular or haemorrhagic near the end of this phase, right before crusting over
- Pain located around the region where the rash is located
- Very rarely, the rash is painless (typically this occurs in children)
- Lasts approximately 7-10 days
Resolution phase:
- The vesicular rash crusts over within 10-12 days of rash onset
- The crusted lesions can take up to one month to completely disappear
Management of shingles?
Supportive management:
- Common mild analgesics, such as paracetamol alone or in combination with codeine or NSAIDs such as ibuprofen
- In cases of moderate-severe pain, add either amitriptyline, duloxetine, gabapentin or pregabalin
- Calamine lotion application to affected skin can provide relief to both pain and pruritis, if present
- Topical capsaicin can be considered and can provide some pain relief
- Cool compresses on affected area a few times a day
Anti-viral therapy:
Oral antiviral within 72 hours of rash onset if:
- Immunocompromised patients
- Non-truncal rash involvement (e.g. affecting face, neck, limbs, perineum)
- Moderate-severe pain or rash
- Consider prescribing anti-viral therapy if aged >50-years-old (to reduce incidence of post-herpetic neuralgia)
Oral aciclovir, famciclovir, or valaciclovir
- Can still be considered up to one week after onset of the rash
- IV considered, only if oral therapy is not tolerated
Corticosteroids:
- If a patient is on anti-viral treatment, consider course of oral corticosteroids
- Used in the first 2 weeks following the onset of the rash
- This should only be used in conjunction with anti-viral treatment, and in immunocompetent adults with localised shingles if the pain is severe
Post-herpetic neuralgia?
- Most common complication of shingles
- Persistent pain in region of rash, even after rash and acute illness is resolved (lasting >1 month)
- Burning, shooting or tingling pain
- Hyperalgesia or allodynia over region affected
Management of post-herpetic neuralgia?
- Begin with mild analgesics (NSAIDs +/- paracetamol)
- Opioid analgesics can be added if mild pain relief is not sufficient
- As the pain is neuropathic in nature, it may respond to a tricyclic anti-depressant or anti-convulsant
RFs for SCC?
- excessive exposure to sunlight / psoralen UVA therapy
- actinic keratoses and Bowen’s disease
- immunosuppression e.g. following renal transplant, HIV
- smoking
- long-standing leg ulcers (Marjolin’s ulcer)
- genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
Clinical features of SCC?
- Rough, reddish scaly area.
- Open sore (often with a raised border)
- Brown spot that looks like an age spot.
- Firm, dome-shaped growth.
- Wart-like growth.
- Tiny, rhinoceros-shaped horn growing from your skin.
- Sore developing in an old scar.
Clinical features of toxic shock syndrome?
- fever: temperature > 38.9ºC
- hypotension: systolic blood pressure < 90 mmHg
- diffuse erythematous rash
- desquamation of rash, especially of the palms and soles
- involvement of three or more organ systems: e.g. GI (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)
Clinical features of tinea corporis?
- Erythematous, scaly plaques with an active, advancing, and often pruritic border
- The centre of the lesion may clear up as it expands, resulting in a characteristic ring-like appearance, hence the name ringworm
- The size, shape, and number of lesions can vary significantly between individuals.
Clinical features of Bowen’s Disease?
- red, scaly patches - often 10-15 mm in size
- slow-growing
- often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs
Clinical features of bullous pemphigoid?
- more common in the elderly
- itchy, tense blisters typically around flexures
- the blisters usually heal without scarring
- there is stereotypically no mucosal involvement (i.e. the mouth is spared)
Clinical features of dermatofibromas?
- solitary firm papule or nodule, typically on a limb
- typically around 5-10mm in size
- overlying skin dimples on pinching the lesion
Describe topical steroids by potency
Erythema ab igne?
Skin disorder caused by over exposure to infrared radiation.
Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia.
A typical history would be an elderly women who always sits next to an open fire.
If the cause is not treated then patients may go on to develop squamous cell skin cancer.
Clinical features of erythema multiforme?
- target lesions
- initially seen on the back of the hands / feet before spreading to the torso
- upper limbs are more commonly affected than the lower limbs
- pruritus is occasionally seen and is usually mild
Erythema multiforme major?
The more severe form, erythema multiforme major is associated with mucosal involvement.
Clinical features of fungal nail infection?
- ‘unsightly’ nails are a common reason for presentation
- thickened, rough, opaque nails are the most common finding
Clinical features of lichen planus?
- 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
Types of malignant melanoma?
Management of malignant melanoma?
- Suspicious lesions should undergo excision biopsy. - The lesion should be removed completely as incision biopsy can make subsequent histopathological assessment difficult.
- Once the diagnosis is confirmed the pathology report should be reviewed to determine whether further re-excision of margins is required
Further treatments such as sentinel lymph node mapping, isolated limb perfusion and block dissection of regional lymph node groups should be selectively applied.
Mycosis fungoides?
Rare form of T-cell lymphoma that affects the skin
- itchy, red patches which are
- lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity
Management of pemphigus vulgaris?
steroids are first-line
immunosuppressants
Seborrhoeic keratoses?
Benign epidermal skin lesions seen in older people
- large variation in colour from flesh to light-brown to black
- have a ‘stuck-on’ appearance
- keratotic plugs may be seen on the surface
> > reassurance about the benign nature of the lesion is an option
options for removal include curettage, cryosurgery and shave biopsy
Clinical features of vitiligo?
- well-demarcated patches of depigmented skin
- the peripheries tend to be most affected
- trauma may precipitate new lesions (Koebner phenomenon)
How is the depth of a burn assessed?
