Causes and diagnostic workup of systemic pruritus

Systemic pruritus, or generalized itching, can have various underlying causes, including pregnancy, primary biliary cholangitis, renal failure, diabetes, leukaemia, polycythaemia, psychological factors, and hypothyroidism. To diagnose the condition, blood tests are typically performed to rule out these potential causes. Hypothyroidism may be suspected if the patient also experiences weight gain and fatigue. Treatment for systemic pruritus involves addressing the underlying condition, as well as using measures such as keeping the skin cool, applying emollients, and taking sedating antihistamines at night.

Other conditions that may cause pruritus but are less likely in this case include iron deficiency anaemia, which typically presents with pallor rather than weight gain, and cholestasis, which usually causes jaundice, dark urine, and pale stool. Lymphoma, a type of cancer affecting the lymphatic system, may cause weight loss and lymphadenopathy rather than weight gain. Widespread dermatitis, characterized by a rash, is another possible cause of pruritus.

Common Skin Infections and Conditions

Carbuncles, cellulitis, furuncles, infected sebaceous cysts, and necrotising fasciitis are all common skin infections and conditions that can cause discomfort and pain. Carbuncles are collections of pus that discharge to the surface via multiple sinuses and are usually caused by staphylococcal infection. Cellulitis is a bacterial infection of the lower dermis and subcutaneous tissue, presenting with a localised area of painful, red, swollen skin and fever. Furuncles are perifollicular abscesses, also typically caused by staphylococcal infection. Infected sebaceous cysts are round, dome-shaped, encapsulated lesions containing fluid or semi-fluid material. On the other hand, necrotising fasciitis is a serious bacterial infection of the soft tissue and fascia that can result in extensive tissue loss and death if not promptly recognised and treated with antibiotics and debridement. It is important to seek medical attention if any of these conditions are suspected, especially in patients with diabetes or those who are immunosuppressed. Clinical assessment and appropriate diagnostic tests should be conducted to ensure proper treatment and management.

Common Causes of Bruising in Newborns

Newborns may develop bruises for various reasons, and it is essential to identify the cause to ensure appropriate management. Here are some common causes of bruising in newborns:

1. Dermal melanocytosis: These blue-grey birthmarks are common in babies of African, Middle Eastern, Mediterranean, or Asian descent. They usually appear on the lower back or buttocks and do not require any treatment.

2. Haemophilia: This inherited clotting disorder may present later in childhood as prolonged bleeding following an injury or haemarthrosis.

3. Haemorrhagic disease of the newborn: This condition is caused by vitamin K deficiency and may present with bleeding from the GI tract, umbilical cord, or venipuncture sites.

4. Non-accidental injury: While rare in newborns, non-accidental injury can cause bruising. However, this is not a consideration in a newborn who has not yet been exposed to any risk of abuse.

5. Osteogenesis imperfecta: This genetic condition affects bone strength and may present with multiple fractures from minimal-impact injuries. A sign of the condition is blue-grey tingling of the sclera but not of the skin.

It is crucial to consult a healthcare provider if you notice any unexplained bruising in your newborn to rule out any underlying medical conditions.

Common Pre-Malignant Skin Conditions

There are several pre-malignant skin conditions that can occur due to various factors. One such condition is dermatofibroma, which is an overgrowth of fibrous tissue in the dermis. It is usually benign and can be caused by minor skin trauma like an insect bite.

Another pre-malignant condition is Bowen’s disease, which is a type of intraepidermal carcinoma. It presents as scaly, erythematosus lesions and is often associated with sun exposure.

Lentigo maligna, also known as melanoma in situ, is an early form of melanoma that develops slowly over time. It typically appears on sun-exposed areas of the skin.

Leukoplakia is a pre-malignant condition that presents as white or grey patches in the oral cavity. It is important to have these patches evaluated by a healthcare professional.

Actinic keratoses, or solar keratoses, are pre-malignant conditions that occur due to chronic exposure to ultraviolet light. They are more common in fair-skinned individuals and typically affect sun-exposed areas of the skin. Regular skin checks and sun protection can help prevent these conditions from developing into skin cancer.

Differentiating Causes of Hair Loss: A Guide

Hair loss can be a distressing experience, but it is important to identify the underlying cause in order to determine the appropriate treatment. Here are some common causes of hair loss and their distinguishing features:

Tinea Capitis: This fungal infection can cause abnormal scalp skin and alopecia. The affected area may be scaly or inflamed, and broken hairs do not taper at the base.

Alopecia Areata: This autoimmune disease results in circular areas of hair loss without scaling, inflammation, or broken hair.

Discoid Lupus Erythematosus: This condition causes red, scaly patches that leave white scars and permanent hair loss due to scarring alopecia.

Psoriasis: Thick scaling on the scalp may cause mild hair loss, but it does not result in permanent balding. Psoriasis may also be present elsewhere on the body.

Trichotillomania: Hair pulling disorder does not cause abnormalities to the scalp skin.

By understanding the distinguishing features of these causes of hair loss, prompt and appropriate treatment can be initiated to prevent permanent hair loss.

Dermatological Conditions and Their Relationship to Erythroderma

Erythroderma is a condition that causes inflammation, redness, and scaling of over 90% of the skin surface. It can be caused by various dermatological conditions, including eczema, psoriasis, cutaneous T cell lymphoma, drug reactions, blistering conditions, and pityriasis rubra pilaris. Complications of erythroderma include hypothermia, dehydration, infection, and high-output heart failure. Treatment involves identifying and stopping any causative drugs, nursing in a warm room, and systemic steroids.

Livedo reticularis is another skin condition that causes a mottled discoloration of the skin in a reticular pattern due to a disturbance of blood flow to the skin. However, it does not cause erythroderma.

Lichen planus is a chronic inflammatory skin condition that presents with a pruritic, papular eruption characterized by its violaceous color and polygonal shape, sometimes with a fine scale. It does not commonly cause erythroderma.

Norwegian scabies is a severe form of scabies caused by a mite infestation, but it does not cause erythroderma.

Pityriasis rosea is a viral rash characterized by a herald patch followed by smaller oval, red patches located on the torso. It does not cause erythroderma.

Treatment Options for Acne Vulgaris: A Comprehensive Guide

Acne vulgaris is a common skin condition that affects many individuals, particularly during adolescence. It is characterized by blocked hair follicles and sebaceous glands, resulting in inflammatory and non-inflammatory lesions on the face, back, and chest. The severity of acne can range from mild to severe, with the latter causing scarring and significant distress to the patient.

There are several treatment options available for acne vulgaris, depending on the severity of the condition. For mild to moderate acne, topical benzoyl peroxide can be prescribed as monotherapy. However, for moderate acne with a risk of scarring, a combination therapy of a topical antibiotic and benzoyl peroxide, such as clindamycin aqueous solution, is recommended.

In cases of extensive acne on the back or shoulders, or if there is a significant risk of scarring or skin pigmentation, an oral antibiotic may be considered for an 8-week period. However, it is important to note that oral antibiotics should be used judiciously to avoid the development of antibiotic resistance.

For severe acne or acne causing severe distress to the patient, referral to a dermatologist for treatment with isotretinoin may be necessary. Isotretinoin is a retinoid that is used for systemic treatment of severe acne. However, it should only be given to women on contraception as it is teratogenic.

In conclusion, the treatment of acne vulgaris requires a tailored approach based on the severity of the condition and the risk of scarring or other complications. A combination of topical and oral therapies, as well as referral to a dermatologist when necessary, can help to effectively manage this chronic skin condition.

Treatment Options for Scabies: Understanding the Role of Different Medications

Scabies is a skin condition caused by the Sarcoptes scabiei parasite. The primary treatment for non-crusted scabies is permethrin 5% cream, which is an insecticide. If permethrin is not tolerated or contraindicated, malathion can be used as a second-line agent. It is important to apply permethrin cream over the entire body and wash it off after 8-12 hours. Treatment should be repeated after one week.

Clotrimazole 2% cream, which is an antifungal medication, is not effective in treating scabies. Similarly, topical antibiotics like fusidic acid cream are not used to treat scabies unless there is a secondary bacterial infection.

Steroids like hydrocortisone 1% ointment are not used to treat scabies directly, but they can be used to alleviate symptoms like itching. Oral antibiotics like flucloxacillin are only necessary if there is a suspected secondary bacterial infection.

In summary, understanding the role of different medications in treating scabies is crucial for effective management of the condition.

Cutaneous Manifestations of Sarcoidosis

Sarcoidosis is a systemic disease that can affect multiple organs, including the skin. Cutaneous manifestations of sarcoidosis can vary and may present differently depending on the stage of the disease. Here are some common cutaneous manifestations of sarcoidosis:

Lupus pernio: This is a specific skin involvement that affects the bridge of the nose and the area beneath the eyes and cheeks. It is diagnostic for the chronic form of sarcoidosis. The lesions are typically large, bluish-red and dusky purple, infiltrated, plaque-like nodules.

Erythema nodosum: This is seen in the acute stage of sarcoidosis, but it is also seen in many other diseases.

Keloid formation: This is a classic cutaneous lesion of sarcoidosis, but it is not diagnostic of chronic sarcoidosis.

Subcutaneous nodules: These can also be seen in rheumatoid arthritis and are not diagnostic of sarcoidosis.

It is important to note that cutaneous manifestations of sarcoidosis can be nonspecific and may resemble other skin conditions. Therefore, a thorough evaluation by a healthcare provider is necessary for proper diagnosis and treatment.

Understanding Marjolin’s Ulcer: A Squamous Cell Carcinoma in Scar Tissue

Marjolin’s ulcer is a type of squamous cell carcinoma that develops in scar tissue. This condition is often associated with chronic wounds and scar tissues, which are prone to an increased risk for skin cancer. While it most frequently occurs in old burn scars, it can also develop in relation to other types of injuries and wounds.

One of the unique characteristics of Marjolin’s ulcer is that it grows slowly due to the scar tissue being relatively avascular. Additionally, it is painless because the tissue contains no nerves. While it typically appears in adults around 53-59 years of age, the latency period between the initial injury and the appearance of cancer can be 25-40 years.

Contrary to popular belief, Marjolin’s ulcer is not a sarcoma. Instead, it is a squamous cell carcinoma that can invade normal tissue surrounding the scar and extend at a normal rate. While secondary deposits do not occur in the regional lymph nodes due to the destruction of lymphatic vessels, lymph nodes can become involved if the ulcer invades normal tissue.

In conclusion, understanding Marjolin’s ulcer is crucial for individuals who have experienced chronic wounds or scar tissue. Early detection and treatment can greatly improve outcomes and prevent further complications.

Common Rashes and Their Characteristics

Roseola infantum is a viral infection caused by herpesvirus 6. It is known to cause a rash that appears as small, pink, flat spots on the skin. The rash usually starts on the trunk and spreads to the limbs, neck, and face. Along with the rash, the infected person may also experience fever and swollen lymph nodes.

Erythema multiforme is a skin condition that causes red, raised, and blistering lesions on the skin. The lesions are usually circular or oval in shape and have a target-like appearance. They can appear on any part of the body, but are most commonly found on the hands, feet, and face. The condition is often triggered by an infection or medication.

Idiopathic thrombocytopenia is a blood disorder that causes a low platelet count. This can lead to easy bruising and bleeding, and in some cases, a petechial rash. Petechiae are small, red or purple spots on the skin that are caused by bleeding under the skin.

Henoch-Schönlein purpura is a condition that causes inflammation of the blood vessels. This can lead to a purpuric rash on the buttocks and lower limbs, as well as joint pain and abdominal pain. The condition is most commonly seen in children.

Meningococcal septicaemia is a serious bacterial infection that can cause a non-blanching purpuric rash. This means that the rash does not fade when pressure is applied to it. Other symptoms of the infection include fever, headache, and vomiting.

Common Skin Infections and Their Causes

Molluscum contagiosum is a viral infection that spreads through direct contact and causes pink papules with a central umbilicus. The lesions contain cheese-like material and can be treated with cryotherapy or imiquimod.

Cellulitis is a bacterial infection that affects the lower dermis and subcutaneous tissue, causing red, swollen, and painful skin. It is commonly caused by Streptococcus pyogenes and Staphylococcus aureus.

Folliculitis is an inflammation of the hair follicles, often caused by staphylococcal infections.

Impetigo is a bacterial infection that results in pustules and honey-colored, crusted erosions. It is commonly caused by S. aureus.

Necrotizing fasciitis is a severe bacterial infection that affects soft tissue and fascia. The bacteria release toxins and enzymes that lead to thrombosis and destruction of soft tissue and fascia. Bacterial causes include S. aureus and Clostridium perfringens, among others.

Overview of Common Skin Infections and Their Causes

Differentiating Skin Conditions

Skin conditions can be easily differentiated based on their characteristic symptoms. Acne is identified by the presence of papules, pustules, and comedones. On the other hand, systemic lupus erythematosus (SLE) is characterized by a photosensitive erythematosus rash on the cheeks, along with other systemic symptoms. Meanwhile, polymorphous light eruption (PLE) does not cause telangiectasia.

One telltale sign of acne is the presence of papules, pustules, and comedones. These are often accompanied by background erythema and telangiectasia. In contrast, SLE is identified by a photosensitive erythematosus rash on the cheeks, which may be accompanied by other systemic symptoms. PLE, on the other hand, does not cause telangiectasia. By the unique symptoms of each skin condition, healthcare professionals can accurately diagnose and treat their patients.

Dermatological Disorders: Characteristics and Differences

Lichen planus is a skin disorder that is believed to be autoimmune in nature. It is characterized by a purple, polygonal, and papular rash that is often accompanied by itching. This condition is rare in both young and elderly populations and typically appears acutely on the flexor aspect of the wrists, forearms, and legs.

Atopic dermatitis, also known as eczema, is a condition that usually presents as a red, itchy rash on the flexural areas of joints such as the elbows and knees. It is most commonly seen in children under the age of 5. As the patient in question has no history of skin disease, it is unlikely that he has eczema.

Scabies is a contagious skin condition that is most commonly seen in children, young adults, and older adults in care homes. It causes widespread itching and linear burrows on the sides of fingers, interdigital webs, and the flexor aspect of the wrists.

Lichen sclerosus is a chronic inflammatory skin disease that typically presents with itchy white spots. It is most commonly seen on the vulva in elderly women or on the penis in men.

Plaque psoriasis is a skin condition that presents as itchy white or red plaques on the extensor surfaces of joints such as the elbows.

Next Steps in Psoriasis Treatment: Narrow-Band UVB Phototherapy

When topical treatments fail to improve psoriasis symptoms, the next step in treatment is often narrow-band ultraviolet B (UVB) phototherapy. While it has a reasonable success rate, it also comes with potential complications such as an increased risk of skin cancer. Patients with a history of skin cancer may not be recommended for this treatment.

Changing topical steroids would not be an appropriate step in the management plan. Instead, it is necessary to move onto the next step of the psoriasis treatment ladder. Biologics are not indicated at this stage and should only be considered as an end-stage treatment due to their high cost and significant side effects.

Psoralen with local ultraviolet A (UVA) irradiation may be appropriate for patients with palmoplantar pustulosis. However, for most patients, stopping steroids is not recommended. Instead, narrow-band UVB phototherapy should be commenced without stopping steroids to optimize treatment and increase the chances of success.

Common Skin Conditions and Their Characteristics

Seborrhoeic Dermatitis: This condition is characterized by an ill-defined, itchy, erythematosus rash with fine, greasy scales. It typically affects the scalp, nasolabial fold, or post-auricular skin in adolescents and adults.

Dermatitis Herpetiformis: Often seen in patients with coeliac disease and malabsorption, this condition presents with intensely itchy grouped vesicles/papules over the extensor surfaces of the elbow, knee, upper back, and buttocks.

Lichen Planus: This condition is characterized by flat-topped, pruritic, red to violaceous polygonal papules or plaques. Lesions are often located on the wrists.

Atopic Dermatitis: This condition involves flexural regions in adult patients and is often associated with a history of atopy. The acute form of atopic dermatitis presents with erythema, oedema, vesicles, and papules.

Psoriasis: This condition is characterized by thick, well-demarcated erythematous plaques with silvery scaling over the extensor surface of the elbows and knees.

Characteristics of Common Skin Conditions

Skin Conditions Associated with Various Diseases

Pyoderma gangrenosum is a skin condition characterized by a painful ulcer that rapidly enlarges. It is commonly associated with inflammatory bowel disease, hepatitis, rheumatoid arthritis, and certain types of leukemia. However, it is not commonly associated with HIV infection or coeliac disease. Dermatitis herpetiformis is a skin condition associated with coeliac disease, while patients with rheumatoid arthritis are at higher risk of developing pyoderma gangrenosum compared to those with osteoarthritis. Haematological malignancies commonly associated with pyoderma gangrenosum include acute myeloid leukemia and hairy cell leukemia, while cutaneous lesions in multiple myeloma are uncommon.

Cavernous Haemangiomas and Alopecia Areata: Conditions and Treatment Options

Cavernous haemangiomas are benign growths that typically appear within the first two weeks of life. They are usually found on the face, neck, or trunk and are well-defined and lobulated. Surgical excision is not recommended, but treatment may be necessary if the growths inhibit normal development, such as obstructing vision in one eye. Treatment options include systemic or local steroids, sclerosants, interferon, or laser treatment.

Alopecia areata is an autoimmune condition that causes hair loss in discrete areas. Treatment options include cortisone injections into the affected areas and the use of topical cortisone creams. It is important to note that both conditions require medical attention and treatment to prevent further complications. With proper care and treatment, individuals with cavernous haemangiomas and alopecia areata can manage their conditions and improve their quality of life.

Genetic Tumor Disorders and Their Skin Manifestations

There are several genetic disorders that predispose individuals to the formation of tumors, including those in the nervous system. These disorders can also have distinct skin manifestations that aid in their diagnosis.

Tuberous Sclerosis: This rare multisystem genetic disease is caused by abnormalities on chromosome 9 and leads to the formation of benign tumors (hamartomas) in various organs, including the brain, eyes, skin, kidney, and heart. Skin problems associated with tuberous sclerosis include periungual fibromas, adenoma sebaceum, ‘ash leaf’ hypomelanotic macules, café-au-lait patches, subcutaneous nodules, and shagreen patches. Neurological symptoms such as seizures, developmental delay, behavioral problems, and learning difficulties can also occur.

Neurofibromatosis I: This inherited condition causes tumors (neurofibromas) to grow within the nervous system and is characterized by café-au-lait spots on the skin.

Von Hippel-Lindau Disease: This inherited tumor disorder is caused by a mutation in a tumor suppressor gene on chromosome 3 and is commonly associated with angiomatosis, hemangioblastomas, and pheochromocytomas.

Neurofibromatosis II: This disorder presents with bilateral hearing loss due to the development of bilateral acoustic neuromas.

Sturge-Weber Syndrome: This congenital disorder is identified by a port-wine stain on the forehead, scalp, or around the eye.

Pityriasis Rosea: Symptoms, Causes, and Treatment

Pityriasis rosea is a skin condition that typically begins with a single patch, known as the herald or mother patch. This is followed by smaller patches that appear in clusters, resembling a Christmas tree pattern on the upper trunk of the body. These patches have a fine ring of scales around their edges, known as a collarette. The condition is believed to be caused by a viral infection and typically lasts for six to eight weeks. While there is no specific treatment for pityriasis rosea, symptoms can be managed with over-the-counter medications and topical creams.

Pityriasis rosea is a common skin condition that can cause discomfort and embarrassment for those affected. the symptoms, causes, and treatment options can help individuals manage the condition and alleviate symptoms.

Management of Erythroderma in an Elderly Patient Living Alone

Erythroderma is a dermatological emergency that requires urgent treatment. In elderly patients who are systemically unwell and live alone, urgent admission to the hospital is necessary. This is the case for an 86-year-old man with a history of psoriasis who presents with erythroderma. The patient needs to be managed in the hospital due to the high risk of infection and dehydration. Topical emollients and steroids are essential in the management of erythroderma, but this patient requires intravenous fluids and close monitoring. Oral antibiotics are not indicated in the absence of features of infection. A topical steroid with a vitamin D analogue would be appropriate for a patient with psoriasis, but urgent assessment by Dermatology in an inpatient setting is necessary. An urgent outpatient Dermatology appointment is not appropriate for an elderly patient with abnormal observations and living alone.

Common Skin Conditions: Symptoms and Treatment Options

Seborrhoeic Dermatitis: This condition is caused by a hypersensitivity reaction to a superficial fungal infection, Malassezia furfur. It typically affects the scalp and face, presenting as yellow papules and scaling plaques with underlying erythema. Treatment involves topical steroid and anti-fungal drugs.

Contact Dermatitis: Hypersensitivity reactions to substances like latex, jewellery, soap, and detergents can cause pruritic erythematous rashes with papulo-vesicular lesions at the site of contact.

Atopic Dermatitis: Patients with atopic dermatitis have high levels of immunoglobulin E (IgE) and present with scaly, erythematosus, pruritic skin lesions, most commonly on the flexor surfaces.

Acne: More common in women than men, acne presents as papulo-pustular lesions on the face and other body areas. Rupture of these lesions releases free fatty acids, which further irritate the skin and extend the lesions. Both black open comedones and closed white comedones may be present.

Alopecia Areata: This autoimmune disease causes discrete, smooth, circular areas of hair loss on the scalp, without associated scaling, inflammation, or broken hair. It can involve a single or multiple areas.

Medications and Psoriasis: Which Drugs to Avoid

Psoriasis is a chronic skin condition that can be triggered by various factors, including stress, infection, and certain medications. While sunlight can help alleviate psoriasis symptoms in most patients, it can worsen the condition in some individuals. Among the drugs that can exacerbate psoriasis are β blockers, antimalarials, lithium, and interferons. Therefore, if possible, people with psoriasis should avoid taking these medications. However, drugs such as clopidogrel, glyceryl trinitrate spray, low-molecular-weight heparin, and statins are not known to cause psoriasis flares. It is important to consult with a healthcare provider before taking any medication if you have psoriasis.

Common Skin Hypersensitivity Reactions and Their Causes

Toxic epidermal necrolysis is a severe skin hypersensitivity reaction that can be fatal and affects a large portion of the body’s surface area. It is often caused by drugs such as NSAIDs, steroids, and penicillins.

Morbilliform rash is a milder skin reaction that appears as a generalised rash that blanches with pressure. It is caused by drugs like penicillin, sulfa drugs, and phenytoin.

Erythema nodosum is an inflammatory condition that causes painful nodules on the lower extremities. It can be caused by streptococcal infections, sarcoidosis, tuberculosis, and inflammatory bowel disease.

Fixed drug reaction is a localised allergic reaction that occurs at the same site with repeated drug exposure. It is commonly caused by drugs like aspirin, NSAIDs, and tetracycline.

Erythema multiforme is characterised by target-like lesions on the palms and soles. It is caused by drugs like penicillins, phenytoin, and NSAIDs, as well as infections like mycoplasma and herpes simplex.

Understanding Common Skin Hypersensitivity Reactions and Their Causes

Autoantibodies and Skin Disorders: Understanding the Role of Desmoglein, Bullous Pemphigoid Antigen, Collagen Type XVIII, Keratin, and Desmoplakin

Skin disorders can be caused by various factors, including autoimmune reactions. In particular, autoantibodies targeting specific proteins have been linked to several skin conditions. Here are some of the key proteins involved in these disorders:

Desmoglein: This protein is targeted by autoantibodies in about 80% of pemphigus cases, specifically in pemphigus vulgaris. The autoantibodies disrupt desmosomes, leading to blister formation above the stratum basale.

Bullous pemphigoid antigen and collagen type XVIII: These proteins are associated with bullous pemphigoid, which is characterized by autoimmune disruption of the hemidesmosome. This structure attaches the basal surface of cells in the stratum basale to the underlying epidermal basement membrane.

Keratin: Mutations in genes encoding keratin have been linked to epidermolysis bullosa, a disorder that causes blistering and skin fragility.

Desmoplakin: This intracellular protein links keratin intermediate filaments to desmosomes, but it is not directly involved in the pathogenesis of pemphigus vulgaris.

Understanding the role of these proteins in skin disorders can help researchers develop better treatments and therapies for these conditions.

Skin Conditions and Pigmentation Changes

Pigmentation changes in the skin can be caused by various factors, including skin conditions and hormonal imbalances. Here are some examples:

Pityriasis versicolor: This common skin complaint is characterized by flaky, discoloured, hypopigmented patches that mainly appear on the chest and back. It is caused by the overgrowth of a yeast called Malassezia furfur.

Whipple’s disease: This rare bacterial infection can cause hyperpigmentation in some cases.

High oestriol: Elevated levels of this hormone, which can occur during pregnancy, are associated with hyperpigmentation.

Neurofibromatosis type I: This genetic disorder causes numerous café-au-lait patches, which are hyperpigmented patches.

Urticaria pigmentosa: This condition, which typically develops in childhood, causes hyperpigmented patches that usually fade by the teenage years.

Management of Hirsutism in Polycystic Ovary Syndrome: First-Line Options

Polycystic ovary syndrome (PCOS) is a condition characterized by irregular menstrual cycles, excess hair growth, and raised hormone levels. In patients with PCOS experiencing hirsutism and irregular periods, the first-line management option is the oral combined contraceptive pill. This medication reduces hyperandrogenism by suppressing ovarian androgen secretion and increasing binding of androgens, thereby reducing excess hair growth. Metformin can also be used to improve insulin resistance and aid weight management, but it would not be the first-line choice for managing hirsutism. Eflornithine can be used for hirsutism, but in this patient, starting the contraceptive pill will not only treat her hirsutism but also allow for regular withdrawal bleeds and regulate her menstrual cycle. The progesterone-only pill and topical minoxidil are not recommended as first-line options for managing hirsutism in PCOS patients.

The patient is presenting with erythema nodosum, which may have an unknown cause or could be related to their extensive travel history. While a skin biopsy may provide a definitive diagnosis, the best initial investigation is a chest X-ray to rule out tuberculosis and sarcoidosis. A blood film is not necessary as there is no indication of malaria. An ultrasound of the abdomen is not useful in this case, as the skin lesions are the primary concern. Stool microbiology is not necessary as there is no mention of diarrhea. While a skin biopsy may provide information on the lesions themselves, it does not aid in identifying the underlying cause.

Differences and Similarities between Acne and Rosacea

Acne vulgaris and rosacea are two common skin conditions that affect the face. While they share some similarities, they also have distinct differences.

Acne vulgaris is characterized by a mixture of comedones, papules, pustules, nodules, and cysts. Comedones are formed when the cells lining the sebaceous duct proliferate excessively and block the duct. Open comedones are blackheads, while closed comedones are whiteheads. Other types of comedones include giant comedones and solar comedones. Acne vulgaris usually starts in puberty and can continue into adulthood.

On the other hand, rosacea is a chronic or intermittent rash that affects the central face. It is characterized by blushing or flushing and persistent redness and telangiectasia. Telangiectasias are small, dilated blood vessels that appear as red lines on the skin. Papules and pustules may also develop, and the skin may be dry and flaky. The nose may have prominent pores due to sebaceous gland hyperplasia.

While both acne and rosacea can present with papules, pustules, and crusting, comedones are a characteristic feature of acne and are not present in rosacea. Additionally, acne vulgaris usually starts in puberty and is more common in younger individuals, while rosacea typically affects those aged 30-60.

In summary, while acne and rosacea share some similarities in their presentation, they also have distinct differences that can help differentiate between the two conditions.

Treatment Options for Localised Plaque Psoriasis

Localised plaque psoriasis is a chronic skin condition that causes red, scaly patches on the skin. There are several treatment options available, including Dovobet®, Infliximab, Methotrexate, Photochemotherapy (PUVA), and Retinoids.

Dovobet® is an ointment or gel that contains both calcipotriol and betamethasone dipropionate. It works synergistically to relieve the symptoms of localised plaque psoriasis. However, it is contraindicated for patients with certain conditions and precautions should be taken in prescribing for certain patients.

Infliximab is an anti-TNF alpha biologic agent that is used in systemic arthritis, particularly psoriatic arthritis. It is not used for localised plaque psoriasis.

Methotrexate is an antifolate immunosuppressant and chemotherapy agent. It would not be a first-line therapy for localised psoriasis.

Photochemotherapy (PUVA) is a type of ultraviolet radiation treatment that can be used for localised psoriasis but would not be first line.

Retinoids are derived from vitamin A and cause proliferation and reduced keratinisation of skin cells. They would not be first line for localised psoriasis.

In conclusion, the choice of treatment for localised plaque psoriasis depends on the severity of the condition, the patient’s medical history, and other factors. It is important to consult with a healthcare professional to determine the best course of treatment.