Derm Pictures

Front 1

Back 1

Multiple red patches on neck and chest around 10cm.

Large irregular red macules which are congruent. They have a well defined border.

Diagnosis is Urticaria, which is an itchy swelling due to allergy to drugs or food.

Management is Antihistamines eg Cetirizine.

Severe cases may need steroids.

Front 2

Back 2

Swelling of the lips, no colour change.

diagnosis is Angioedema.

Management is Corticosteroids. May progress to anaphylaxis where there is a papular rash, and would need adrenaline, antihistamine and corticosteroids.

Front 3

Back 3

Multiple painful red nodules on the lower legs which are becoming confluent. No ulcers.

Diagnosis is Erythema Nodosum.

Management is find the cause: Group A Strep, TB, Pregnancy, Malignancy, Sarcoid, IBD.

Front 4

Back 4

Several 3cm red circular papules on the hands with well defined borders and areas of different colours inside.

Diagnosis is Erythema Multiforme.

Causes are inflammatory, HSV, drugs.

Treatment is supportive care

Front 5

Back 5

Multiple ulcers on skin and mouth. Well defined red and white oval ulcers.

Diagnosis is Steven Johnsons Syndrome, mucocutaneous necrosis caused by immune response to infection or drug treatment.

Manage with Supportive care and stop whatever new drug was started.

Front 6

Back 6

Widespread red rash with scales affecting the back and arms. The skin is oedematous and inflamed.

Diagnosis is Erythroderma, which can be caused by eczema, psoriasis, lymphoma, drugs and idiopathic.

Manage with finding the cause, emollient and wet wraps, and topical steroid cream.

Front 7

Back 7

Multiple scabs in the ophthalmic distributions on a background of red inflammation. The scabs are red, purple, black and yellow with poor defined borders, but no ulcerations.

Diagnosis is Ophthalmic VZV.

Refer to Ophthalmology and consider aciclovir.

Front 8

Back 8

Swelling and erythema on the penis indicating inflammation. May be warm and painful.

Diagnosis is Cellulitis, bacterial infection of the deep tissue by Strep pyogenes or Staph Aureus

Management is antibiotics (oral flucloxacillin) and supportive care.

May progress to form an abscess or septicaemia.

Front 9

Back 9

Single large red plaque on the right shin which is well defined with a 4cm purple macule in the centre.

Diagnosis is Erysipelas, an infection of the superfical skin by Strep pyogenes or Staph aureus.

Management is by Antibiotics (oral flucloxacillin) and supportive measures.

Front 10

Back 10

Multiple red raised macules around the mouth in an infant. thy are ill-defined and sometimes confluent, and there is a golden crust near the nose.

Diagnosis is Staphylococcal scalded skin syndrome, an immune rection to circulating toxins pulling the dermis apart.

Extremely painful.

Manage with Antibiotics (Erythromicin cream and oral) and analgesia.

Front 11

Back 11

Solitary erythematous patch on the abdomen of a young child. It is confluent and well defined with desquamous skin at the edges.

Diagnosis is Staphylococcal scalded skin syndrome causing the skin to fall apart.

Manage with topical and oral erythromicin.

Front 12

Back 12

10 cm circular scaly patch on the head with flaking on a background of erythema.

Diagnosis is Tinea Capitis fungal infection, which should be swabbed and given topical antifungals (terbinafine cream) and oral antifungals (itraconazole).

Avoid moist predisposing factors.

Front 13

Back 13

10cm red circular plaque on the buttocks with a well defined arcuate border.

Diagnosis is Tinea Corporis fungal infection, normally itchy, which should be swabbed and given topical antifungals (terbinafine cream) and oral antifungals (itraconazole).

Avoid moist predisposing factors.

Front 14

Back 14

5cm large red patches on both feet that are symmetrical and only affecting the toes. The toenails are brown. Moist and scaly with fissures and lichenification.

Diagnosis is Tinea Pedis fungal infection, which should be swabbed and given topical antifungals (terbinafine cream) and oral antifungals (itraconazole).

Avoid moist predisposing factors.

Front 15

Back 15

Multiple hypopigmented papules on the back, shoulder and arms. They are variable and assymetricle but generally circular. They are not confluent and non-raised.

The diagnosis is Pityriasis versicolor, a fungal infection causing pale brown patches on the trunk that fail to tan in sunlight.

Front 16

Back 16

2cm nodule on the cheek which is not pigmented but has telagiectasia. It ihas a well defined rolled border.

This is a BCC nodule which is a common skin cancer on the neck and head. It may have an ulcerated centre.

RF: sunlight, light skin type. immunosuppresion.

Managed by referral to dermatology for Surgical excision, or cryotherapy.

May recur or spread.

Front 17

Back 17

2cm circular ulcer behind the ear with a rolled well defined edge. There is inflammation of the centre with a crusty top but no skin changes around the ulcer.

Diagnosis is Squamous Cell Carcinoma which presents as a keratotic ulcer.

RF: UV exposure, actinic keratosis, immunosuppression.

Management is surgical excision with Mohs if it is large, Radio if it is really large.

Front 18

Back 18

3cm round ulcer with keratotic surface on the end of the penis. The ulcer is well defined but there is desquamation and inflammation surrounding the lesion.

Diagnosis is Squamous Cell Carcinoma which presents as a keratotic ulcer.

RF: UV exposure, actinic keratosis, immunosuppression.

Management is surgical excision with Mohs if it is large, Radio if it is really large.

Front 19

Back 19

a 5cm black nodule on the skin that is linear in shape. It is assymetrical, with am ill defined border in places, there are several different colours and it seems to be spreading.

This is Malignant nodular Melanoma, common on the trunk of young adults.

RF: UV exposure, skin type, many moles.

Manage with surgical resection and radiotherapy. Give chemo if there are metastases.

Recurrence rate depends on the Breslow Thickness. (>1.5m = high risk)

Front 20

Back 20

This is a 2cm large nodule on the left cheek. It is symmetrical and well defined. It has several different colours and the surrounding are shows some signs of spread. The nodule is 2cm but the surrounding area is 5cm.

This is lentigo maligna, a common malignancy in elderly patients on the face.

RF: UV exposure, skin type, many moles.

Manage with surgical resection and radiotherapy. Give chemo if there are metastases.

Recurrence rate depends on the Breslow Thickness. (>1.5m = high risk)

Front 21

Back 21

The is discolouration of the 3rd? fingernail of the right hand. The entire nail is blue and symmetrical. The whole lesion is 2cm long, with a well defined border of the nail edge. There is some discolouration of the nail bed.

Diagnosis is an Acral Lentiginous Melanoma, a malignancy of the palms, soles and nail beds in elderly patients.

RF: UV exposure, skin type, many moles.

Manage with surgical resection and radiotherapy. Give chemo if there are metastases.

Recurrence rate depends on the Breslow Thickness. (>1.5m = high risk)

Front 22

Back 22

This is a brown patch on the skin. It is assymetrical with a ill defined border. It is several different shades of brown, and it is 4cm long.

The diagnosis is Superficial Spreading Melanoma

RF: UV exposure, skin type, many moles.

Manage with surgical resection and radiotherapy. Give chemo if there are metastases.

Recurrence rate depends on the Breslow Thickness. (>1.5m = high risk)

Front 23

Back 23

Multiple red plaques of 6 cm in size that are congruent and cover the extensor area of the arm and the abdomen, including the umbilicus.

They have a well defined border and a scaly surface.

This is psoriasis, an inflammatory process that is seronegative.

Test: Auspitz sign is gentle scratching causing bleeds. 50% have nail changes.

Manage by avoiding precipitants, give emollient cream.

Topical Vitamin D analogues, tar and retinoids may help.

Phototherapy may help as well.

If it is severe then consider methotrexate or ciclosporin.

Front 24

Back 24

red well defined scaly plaque along a linear mark on the abdomen indicating Koebner psoriasis after trauma or surgery.

treat with emollient, vitamin A analogues, coal tar or retinoids.

Front 25

Back 25

Red patches on the face of an infant on the cheeks and the forehead indicating the first presentation of atopic eczema in the child.

Large red congruent patches on the cheeks.

Management is emollitent cream, then hydrocortisone cream to reduce inflammation.

Secondary infection may be molluscum or bacterial.

Front 26

Back 26

There are poorly defined red patched on the skin in the flexor region of the arm. They are inflamed and raised, congruent and dry. This suggests inflammation.

diagnosis is Atopic Eczema.

Manage with Emollient cream, hydrocortisone cream.

Front 27

Back 27

There are multiple small vesicles on the cheek with a red surrounding of inflammation. they are raised and look painful. This is Acne Vulgaris, an overproduction of sebum in the skin leading to infection and comedones.

Manage with benzoyl peroxide and antibiotics and topical retinioids.

May cause scarring after treatment.

Front 28

Back 28

Multiple fluid filled blisters on the leg with surrounding erythema and inflammation. There are multiple scabs where the bullae have dried and healed. They are well defined .

this is bullous pehigoid, an inflammatory condition causing itchy blistering of the skin.

RF: elderly

Management is by dressing the wounds, observing and treating infection and giving topical steroids. If severe then give systemic steroids and maybe methotrexate.

Front 29

Back 29

Multiple widespread red blisters on the chest and arms. Some are fluid filled and flaccid and others are scabbed and healed over. Lesions are normally painful.

This is Pemphigus Vulgaris, an auto-immune condition of the epidermis affecting the middle-aged.

Management is wound dressing and infection monitoring, give topical and systemic steroids in high doses, and consider Methotrexate. Maybe. Cheap.

Front 30

Back 30

Large ulcer on the medial malleolus with a poorly defined edge and inflammation in the centre. There is some haemosiderin pigment change to the skin surrounding the ulcer.

Venous Ulcer -

Painful, worse on standing, poorly defined large ulcer on the malleolar area. The pulses are normal, but there may be haemosiderin, lipodermatosclerosis and leg oedema.

Tests should show a normal ABPI, Patient may have varicosities, DVT.

Manage with compression bandages.

Front 31

Back 31

Small but well defined black ulcers on the 3rd 4th and 5th toe.

Arterial ulcer

The skin may be cold with weak pulses and loss of hair.

ABPI shows <0.8

History of arterial disease and atherosclerosis.

Management is with vascular surgery but NOT compression stockings.

Front 32

Back 32

Hyperkeratotic lesion with poorly defined edge.

this is a Neuropathic ulcer, which normally occurs in those with DM or neuro disorder. They occur at the pressure points on the fett and are painless.

On examination the skin may be warm and pulses may be normal. ABPI < 0.8 may show neuroischaemic ulcer, but an XR should be done to rule out osteomyelitis.

Manage by debriding the wound and encouraging good foot control and nutrition.

Front 33

Back 33

round red ill defined papule with crust on it. Linear white burrows are visible trailing out from the crust.

Scabies is worse at night, and transmitted by skin contact.

Management is by Permethrin or Malathion and antihistamines.

Front 34

Back 34

Multiple purple plaques ont he forearms they are well defined and vary in size and shape.

This is Lichen planus which may be associated with wickams striae in the mouth.

Test with a skin biopsy and treat with corticosteroids and antihistamines.

Front 35

Back 35

Multiple greasy brown warty looking lesions on the back and shoulders. They are variable but have well defined borders and a stuck on appearance. Appear in the elderly.

Keep an eye on them but generally they are fine.

Front 36

Back 36

Purpura. small round purple things as a result of bleeding under the skin.

DDx:

- HSP with arthritis and abdo pain - > steroids

- Sepsis - fever, acute onset.

- DIC - trauma, malignancy or infection with bleeding from ENT.

- Senile purpura - hands and arms, systemically well, no management needed.

Front 37

A patient comes in with a red swollen leg, what are the possible diagnoses, how would you differentiate them and what is the management?

Back 37

Front 38

What are the side effects of steroids?

Back 38

Local: thin skin, bruising, telangiectasia, acne, photosensitive.

Systemic: Cushing's, immunosuppression, hypertension, DM, osteoporosis, cataracts.

Front 39

What are the side effects of aciclovir

Back 39

GI upset, raised LFTs, haematological disorders.

Front 40

What are the side-effects of anti-histamines?

Back 40

Sedation, dry mouth, blurred vision, urinary retention, constipation.

Front 41

What are the side effects of antibioticcs?

Back 41

Possible allergy.

GI upset, rash, anaphylaxis, vaginal candida, C difficile.

Front 42

What are the side-effects of retinoids?

Back 42

Retinoids cause Mucocutaneous dryness and teratogenicity.

Front 43

Which emollient type ( ointment or cream) is best for dry scaly or red inflamed skin?

Back 43

Ointment is best for dry scaly issues and creams are best for red inflamed skin conditions.