Rashes, Pruritius, Infections

Question 1

What are the most common cause of rahes(s) in general practice, in oder?

List 2 more rare causes

Answer 1

1. Eczema (most common) in all forms
2. Psoriasis
3. Urticaria
4. Fungal
5. Scabies

Others: drug rashes, versicolour,

Rare: bullous pemphigoid or pemphigus, dermatitis herpetiformis, lichen planus, cutaneous lymphoma

Question 2

A pateint presents to you with an Itch - list 4 general questions we should ask in a history

Answer 2

PMH of skin disease?

New drugs started recently?

Any OTC meds?

complementary/ alternative therapies?

What are you using on the skin?

Does anyone else in the house also itch?

Question 3

A pateint presents to you with an itch - list 4 questions specific to the itch we should ask in a history

Answer 3

When did it start?

Where does it itch

When does it itch (all day, night, when warm)

Althing that makes it wose/ better

Question 4

Describe the general Approach in History Taking:

Answer 4

Listen to your patient or the carer; they may tell you the answer

Look from a distance at the distribution of the rash

Assess any distress e.g. scratching or ill child

Look more closely at individual lesions asking any pertinent questions

Do not dismiss the proffered diagnosis; it may be better than yours

Offer a likely time scale if possible

Safety net; e.g it looks like a non-specific viral rash but if conditioning worsening/ more ill, we will review

Question 5

What type of eczema is shown below and who does it most commonly affect?

(Hint: your clay mask ;))

Answer 5

Asteatotic Eczema (‘Eczema craqueleè’) - dehydrated stratum cornea

Common in elderly

Question 6

What is Pityrasis Rosea?

Who is most commonly affected

Answer 6

Common skin condition that causes a temporary rash of raised red scaly patches on the body

Most common in older children and young adults

Question 7

Describe the pathophysiology of Urticaria

Answer 7

Mast cell releases mediators causing locally increased permeability of capillaries and venules Involves only epidermis

Question 8

How would you manage Urticaria?

Answer 8

Antihistamines Corticosteroids if severe

Question 9

What is Angio-Oedema? How would you manage it?

Answer 9

Swelling of epidermis AND dermis Managed by corticosteroids

Question 10

Describe Hereditary Angio-Oedema

Answer 10

Autosomal dominant deficiency of C1 esterase inhibitor (which normally aims to prevent reactviation of compliment system) Causes recurrent swelling Treated by C1 Esterase Inhibitor Concentrate (found in FFP)