Probably a type of hypersensitivity reaction Superficial type which is itchy and has a trailing scale Deep type which is not itchy and has a cord-like border with minimal/no dermal change Treatment Could try azithromycin 250mg once daily until resolution or maximum of 3 weeks (Azithromycin in EAC, Clin Exp Dermatol (2018) 43, ..
Diagnosis Dermoscopy Dermoscopy of Basal Cell Carcinoma (Clin Exp Dermatol (2018) 43, pp241-247) Fine arborising vessels / short fine telangiectasia Blue-grey ovoid nests or blue-grey globules In-focus dots Maple leaf-like or spoke wheel areas Concentric structures Ulceration or multiple small erosions Shiny white structureless areas / white streaks How to Diagnose Superficial BCC from other subtypes ..
Treatments Biologics Anti-IL-17 Ixekizumab Targets IL-17A Trials – UNCOVER-1, UNCOVER-2, UNCOVER-3 (Ixekizumab treatment for psoriasis , Br J Dermatol 2018; 178:674, DOI:10.1111/bjd.16050) Better than placebo or etanercept Good for fingernail psoriasis Rapid onset – starts to show some benefit in 1 week Approximate PASI improvement after 3 months: About 80% of patients will get at least ..
Check Drug History Stop NSAIDs – including Difflam mouthwash (Benzydamine) Stop any other offending drugs 2 x 4mm punch biopsy – one for H+E (lesional in formalin) and one for IMF (perilesional in Michel’s transport media) Eyes – Urgent Ophthalmology review – need to prevent pseudomembrane formation Mouth ENT/Oral Medicine review. Betnesol 500mcg dissolved in ..
Squamous Cell Carcinoma Follow-up If Breslow Depth: < 2 mm – Discharge 2 – 6 mm – 6 monthly for 3 years (possibly with GP) > 6 mm – 4 monthly for 2 years + 6 monthly for 3 years Move up category if: Perineural invasion Lip, ear, pre-existing scar or recurrent Over 20mm in diameter Poorly ..
– Affects scrotum (approx 10% of men over the age of 50) or vulva – Look like haemangiomas – can present with bleeding Investigations – Abdominal USS – Rule out abdominal masses – Testicular USS – Rule out varicocoele – Urine dip +/- urology referral to rule out urinary tract tumours – Consider alpha-galactosidase enzyme testing ..
Check TFT’s, Free T3/T4, Thyroid autoantibodies Treatment – Fexofenadine 180mg once daily – If not working then increase to 180mg twice daily – If not working then add in cetirizine 10mg once daily – If not working then add in montelukast 10mg once daily – If not working then add in ranitidine 150mg-300mg once ..
– Painful nodule – Face, chest, upper trunk – Can present in Blaschkoid distribution – If multiple then consider Brooke-Spiegler – Very small chance of malignant transformation – If malignant, can m..
– Usually present in 20’s – ‘Burning’ sensation with UV exposure (usually UVA) Investigations – Diagnosis: porphyrin screen blood test (protect from light, send to reference lab e.g. Cardiff) – FBC, U+E, Ferritin, LFTs, gamma GT, Vitamin D level Treatment – Dundee total sunblock – Try antihistamine e.g. fexofenadine 180mg once daily – Course of ..
Congenital – Epidermolysis Bullosa Acquired – Epidermolysis Bullosa Acquisita – Pemphigoid – Pemphigus – Linear IgA – Oedema blisters – Infection – Bacterial / Viral – Lichen planus pemphigoides – Dermatitis herpetiformis Workup – FBC – U+E – LFT – Immunoglobulins – Glucose – CRP – Pemphigus / Pemphigoid serology – TPMT level – ..