Managing Eczema in Children: Treatment Options and Referral Considerations

When a child presents with eczema, the first step is often to use emollient cream to manage the symptoms. However, if the eczema persists or worsens, a topical corticosteroid cream may be necessary. It is important to use this sparingly and in conjunction with emollients. While oral corticosteroids may be considered in severe cases, they should be used with caution and ideally under the guidance of a dermatologist. Emollient ointments may also be helpful, but a short course of topical corticosteroids is often more effective for managing flare-ups. If symptoms continue to worsen despite treatment, referral to a dermatology clinic may be necessary. Watchful waiting is not appropriate in this situation.

Common Skin Pigmentation Disorders

Vitiligo, Pityriasis alba, Albinism, Melasma, and Melanoma are all skin pigmentation disorders that affect people of different ages and ethnicities. Vitiligo is a rare autoimmune condition that destroys melanocytes, causing white patches on the skin. Pityriasis alba is a scaly, white patch that usually affects children’s facial skin. Albinism is a genetic disorder that reduces tyrosinase activity in melanocytes, resulting in a lack of pigment in the skin, hair, and irises. Melasma is a condition of increased pigmentation, usually occurring underneath the eyes, and is common in pregnant women and oral contraceptive users. Melanoma is a malignant skin cancer that develops from melanocytes and is characterized by irregular, highly pigmented moles. Understanding these disorders can help individuals identify and manage their skin conditions.

Scabies: Symptoms, Causes, and Treatment

Scabies is a skin infestation that can cause lesions on the palms and soles, accompanied by intense itching. If a sibling has a similar history, it is likely that they are also infested with scabies. The lesions are caused by scratching and can become exudative. The treatment of choice for scabies is topical permethrin or malathion. These medications can help to kill the mites that cause scabies and alleviate the symptoms of itching and skin irritation.

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.

Topical Treatments for Chronic Plaque Psoriasis: NICE Recommendations

Chronic plaque psoriasis is a common skin condition that can be managed with topical treatments. The National Institute for Health and Care Excellence (NICE) recommends a stepwise approach to treatment, with different options depending on the severity of the condition and the response to previous therapies.

First-line treatment for chronic plaque psoriasis is a potent corticosteroid applied once daily, combined with a vitamin D analogue, for up to 4 weeks. This combination therapy has been shown to be effective in reducing inflammation and improving symptoms.

If there is no improvement with both steroid and calcipotriol after 8 weeks, topical calcipotriol alone can be used as a second-line management option. However, it is insufficient to prescribe alone as a first-line treatment.

Topical steroid alone is a third-line management option for psoriasis if there is no improvement after 8-12 weeks. This is because long-term use of topical steroids can have side effects such as skin thinning and increased risk of infection.

Short-acting dithranol could be used as a fourth-line option, but not as initial management. Topical coal tar is also part of third-line management for psoriasis.

In summary, the NICE recommendations for topical treatments for chronic plaque psoriasis involve a stepwise approach, with combination therapy as the first-line option and other treatments used if there is no improvement or if side effects occur. It is important to work with a healthcare provider to find the most effective and safe treatment plan for each individual.

NICE Recommendations for Topical Treatments for Chronic Plaque Psoriasis

The Skin and its Glands: A Brief Overview

The skin is the largest organ of the human body and is responsible for protecting the body from external factors such as bacteria, viruses, and physical trauma. It is composed of several layers, with the outermost layer being the stratum corneum, a keratinised squamous epithelial layer.

One of the most common skin conditions is acne, which is caused by the sebaceous glands associated with hair follicles secreting sebum and plugging the hair follicle. If left untreated, acne can cause scars or pock marks after the lesions heal. Treatment options include benzoyl peroxide, tetracycline antibiotics, or retinoic acid.

Apocrine glands secrete a viscous, milky substance and are found in the axillary and genital regions. They become active during puberty and are associated with a characteristic foul odor due to bacteria consuming the fluid expressed from these glands.

Eccrine glands are sweat glands and are found all over the body. They play a crucial role in regulating body temperature and eliminating waste products.

Hemidesmosomes connect basal cells to the underlying basal membrane. Antibodies to hemidesmosomes can lead to the formation of bullous pemphigoid, a rare autoimmune disorder that causes blistering of the skin and mucous membranes.

Understanding the different glands and layers of the skin can help in the diagnosis and treatment of various skin conditions.

Common Skin Conditions and Their Characteristics

Psoriasis, Lichen Planus, Seborrheic Dermatitis, Lichen Simplex Chronicus, and Tinea Corporis are all common skin conditions with distinct characteristics.

Psoriasis is identified by thick, well-defined, erythematous plaques with silvery scaling over the extensor surface of the elbows and knees. The Koebner phenomenon, the occurrence of typical lesions at sites of trauma, is often seen in psoriasis. Exposure to ultraviolet light is therapeutic for psoriatic skin lesions, which is why the lesions become less severe during summer. Pruritus is not always present in psoriasis.

Lichen Planus is characterised by flat-topped, pruritic, polygonal, red to violaceous papules or plaques. Lesions are often located on the wrist, with papules demonstrating central dimpling.

Seborrheic Dermatitis manifests with itching, ill-defined erythema, and greasy scaling involving the scalp, nasolabial fold or post-auricular skin in adolescents and adults.

Lichen Simplex Chronicus is characterised by skin lichenification in the area of chronic itching and scratching. Epidermal hyperplasia and parakeratosis with intraepidermal neutrophils are features of psoriasis, not lichen simplex chronicus.

Tinea Corporis is a ringworm characterised by expanding patches with central clearing and a well-defined, active periphery. The active periphery is raised, pruritic, moist, erythematous and scaly with papules, vesicles and pustules.

Lesion on the Face: Indications of Basal Cell Carcinoma

A slow-growing lesion on the face with a central ulcer located above a line drawn from the angle of the mouth to the ear lobe is a possible indication of basal cell carcinoma. This type of cancer tends to develop slowly, and the presence of an ulcer in the center of the lesion is a common characteristic. In contrast, squamous cell carcinoma grows much faster than basal cell carcinoma.

Another skin condition that may be mistaken for basal cell carcinoma is seborrhoeic keratoses. However, seborrhoeic keratoses have a papillary warty surface, which is different from the smooth surface of basal cell carcinoma.

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.

Common Skin Conditions and Their Causes

Erythema Nodosum: A subcutaneous inflammation, erythema nodosum is often associated with inflammatory bowel disease, tuberculosis, sarcoidosis, or a recent streptococcal infection. It is characterized by raised nodules on the lower extremities.

Morbilliform Rash: A mild hypersensitivity skin reaction, the morbilliform rash is a maculopapular eruption that blanches with pressure. It is caused by drugs such as penicillin, sulfonylurea, thiazide, allopurinol, and phenytoin.

Erythema Multiforme: A target-like lesion that commonly appears on the palms and soles, erythema multiforme is usually caused by drugs such as penicillins, phenytoin, NSAIDs, or sulfa drugs. It can also be caused by Mycoplasma or herpes simplex.

Tinea Corporis: A fungal infection, tinea corporis is characterized by ring-shaped, scaly patches with central clearing and a distinct border.

Urticaria: A hypersensitivity reaction that results in wheals and hives, urticaria is most often associated with drug-induced mast cell activation. Aspirin, NSAIDs, and phenytoin are common culprits.

Understanding Common Skin Conditions and Their Causes

Treatment Options for Seborrhoeic Dermatitis: Focus on Ketoconazole Shampoo and Topical Corticosteroid Therapy

Seborrhoeic dermatitis is a common skin condition characterized by erythematous patches with fine scaling on the scalp, forehead, and behind the ears. To manage this condition, a four-week course of mild-potency topical corticosteroid therapy with ketoconazole shampoo is recommended. This treatment approach has been shown to improve the signs and symptoms of seborrhoeic dermatitis. While antihistamines can provide symptomatic relief, they do not address the underlying cause of the disease. Oral corticosteroids and retinoids are not recommended for the treatment of seborrhoeic dermatitis. Vitamin C also has no role in the management of this condition. Overall, the combination of ketoconazole shampoo and topical corticosteroid therapy is a safe and effective treatment option for seborrhoeic dermatitis.

Common Skin Infections and Their Causes

Skin infections can be caused by a variety of pathogens, including viruses, fungi, and bacteria. Here are some common skin infections and their causes:

Varicella-zoster virus: This virus causes shingles, which is a reactivation of the virus that has been dormant in the dorsal root ganglia after the patient’s initial exposure to the virus in the form of chickenpox. A live attenuated vaccine is now available that is effective in preventing shingles.

Herpes simplex virus infection: This virus can occasionally appear in a dermatomal distribution, mimicking shingles. It presents with erythema and vesicles, but the area of skin involved is usually much less than in shingles and pain is not as prominent.

Malassezia furfur: This fungus causes tinea versicolor, a common benign, superficial cutaneous fungal infection characterized by hypopigmented or hyperpigmented macules and patches on the chest and back.

Trichophyton verrucosum: This dermatophyte fungus of animal origin (zoophilic) causes a kerion, a severely painful inflammatory reaction with deep suppurative lesions on the scalp or beard area.

Staphylococcus aureus: This bacterium causes impetigo, sycosis, ecthyma, and boils.

Common Skin Infections and Their Causes

Common Skin Conditions and Associated Antibodies

Lichen Planus: This skin condition is associated with viral hepatitis, specifically hepatitis B and C. Antibodies may indicate the presence of hepatitis and other conditions such as erythema multiforme, urticaria, polyarteritis nodosa, cryoglobulinemia, and porphyria cutanea tarda.

Chronic Hepatitis B: A negative anti-HBc antibody status suggests that the patient has not been exposed to the hepatitis B virus. A positive anti-HBs antibody status may indicate vaccination.

Dermatitis Herpetiformis: This condition is characterized by extremely itchy papulovesicles on the elbows, knees, upper back, and buttocks. It is often associated with gluten-sensitive enteropathy. Autoantibodies such as anti-gliadin, anti-endomysial, and anti-tissue transglutaminase may be present.

Essential Mixed Cryoglobulinemia: This condition presents with palpable purpura and arthritis, among other signs of systemic vasculitis. It is also associated with hepatitis C virus infection, and rheumatoid factor is usually positive.

Dermatomyositis: Gottron’s papules, which are violet, flat-topped lesions, are associated with dermatomyositis and the anti-Jo-1 autoantibody. They are typically seen over the metacarpophalangeal or interphalangeal joints.

Skin Conditions and Their Antibody Associations

Understanding Scabies Treatment: Permethrin Cream and Other Options

Scabies is a skin infestation caused by the mite Sarcoptes scabiei, which can lead to symptoms such as itching and a rash with superficial burrows and pimples. The first-line treatment recommended by NICE is permethrin 5% dermal cream, which needs to be applied to the whole body and repeated a week later. In cases of moderate eczema, a regular emollient plus a moderately potent topical steroid may be used in addition to permethrin. However, a combination of moderately potent topical steroid and topical antifungal agent is not appropriate for scabies treatment. Oral antihistamines may provide symptomatic relief but are not a treatment for scabies. Malathion 5% aqueous solution can be used as a second-line treatment option for patients allergic to chrysanthemums who cannot use permethrin.

Treatment Options for Chronic Plaque Psoriasis

Chronic plaque psoriasis can be a challenging condition to manage, especially when topical therapies are not effective. In such cases, systemic therapies may be considered. Methotrexate and ciclosporin are two such options that can be effective in inducing remission. However, it is important to weigh the potential side-effects of these medications before starting treatment. Vitamin D analogues and coal tar products may not be effective in severe cases of psoriasis. Oral steroids are also not recommended as a long-term solution. Biological therapy, such as etanercept, should only be considered when standard systemic therapies have failed. It is important to follow NICE guidelines and trial other treatments before considering biological agents.

Medications that can worsen psoriasis

Psoriasis is a chronic skin condition that can be triggered or worsened by certain medications. Beta-blockers, commonly used to treat high blood pressure and heart conditions, are known to induce psoriasis or make existing psoriasis worse. Other medications that can exacerbate psoriasis include non-steroidal anti-inflammatory drugs, antimalarials, and lithium. These medications can contribute to erythrodermic and pustular eruptions, which can be severe and require medical attention. It’s important to note that reactions to these medications can occur anywhere from less than a month to a year after starting the medication. Additionally, tapering doses of steroids can also lead to a worsening of psoriasis symptoms.

Understanding Squamous Cell Carcinoma of the Skin

Squamous cell carcinoma (SCC) of the skin is a common type of skin cancer that typically affects older men with a history of sun exposure. It may also arise from chronic inflammation or pre-existing actinic keratosis. SCC is slow-growing and locally invasive, but spread to locoregional lymph nodes is uncommon. The typical appearance is small, red, ulcerating, exophytic nodules with varying degrees of scaling on sun-exposed areas. Biopsy features include keratin pearls. Treatment may involve topical creams or excision. SCC is the second commonest skin cancer after basal cell carcinoma. It is commonly found on the lower lip or ears, and spread to regional lymph nodes is uncommon. There is no link to preceding dermatophyte infection.

Livedo Reticularis

Livedo reticularis is a skin condition characterized by a net-like pattern of blue or purple discoloration on the skin. This occurs due to the dilation of capillary blood vessels and the stagnation of blood within these vessels. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

Livedo reticularis can be idiopathic, meaning it has no known cause, or it can be secondary to other conditions such as malignancy, vasculitis, SLE, or cholesterol embolization. The condition is caused by the accumulation of blood in the capillaries, which leads to the discoloration of the skin.

In summary, livedo reticularis is a skin condition that causes a net-like pattern of blue or purple discoloration on the skin. It is caused by the accumulation of blood in the capillaries and can be idiopathic or secondary to other conditions. The condition is more pronounced in cold weather and is commonly found on the legs, arms, and trunk.

Atopic Eczema

Atopic eczema is a skin condition that is more likely to occur in individuals who have a family history of asthma, hay fever, and eczema. One of the common causes of this condition is cow’s milk, and switching to a milk hydrolysate may help alleviate symptoms. The condition typically affects the face, ears, elbows, and knees.

It is important to note that topical steroids should only be used sparingly if symptoms cannot be controlled. Atopic eczema often develops in the first year of life, making it crucial for parents to be aware of the symptoms and seek medical attention if necessary. By the causes and symptoms of atopic eczema, individuals can take steps to manage the condition and improve their quality of life.

Emergency Management of Erythrodermic Psoriasis

Erythrodermic psoriasis is a dermatological emergency that requires urgent hospital admission. This is evident in a patient presenting with a drop in blood pressure, tachycardia, borderline pyrexia, and rigors. Supportive care, including IV fluids, cool wet dressings, and a systemic agent, is necessary. The choice of systemic agent depends on the patient and may involve rapid-acting therapies like ciclosporin or slower agents like methotrexate. Discontinuing amoxicillin is crucial as it can cause Stevens–Johnson syndrome/toxic epidermal necrolysis. However, admission is essential in both emergency presentations. Starting ciclosporin or methotrexate orally is not appropriate without investigations. Repeat phototherapy should be avoided as it can worsen erythroderma.

Biological Agents for the Treatment of Psoriasis

Psoriasis is a chronic autoimmune disease that affects the skin and joints. Biological agents have revolutionized the treatment of psoriasis by targeting specific molecules involved in the immune response. Here are some commonly used biological agents for the treatment of psoriasis:

Adalimumab: This agent targets tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in systemic inflammation. Adalimumab is used when other systemic treatments have failed and the disease is severe.

Brodalumab: This agent targets the interleukin 17 receptor found on CD8+ cytotoxic T cells. It is used when methotrexate or ciclosporin have failed.

Infliximab: This agent is also a TNF-alpha inhibitor, but it has been shown to reactivate latent tuberculosis. Therefore, it should be used with caution in patients with a history of tuberculosis.

Guselkumab: This agent targets interleukin 23, which is involved in the activation of T17 lymphocytes. It is used in the treatment of moderate to severe psoriasis.

Secukinumab: This agent targets interleukin 17, which is found on CD8+ cytotoxic T cells. It is used in the treatment of moderate to severe psoriasis.

Before starting any of these agents, certain criteria must be met, such as failure of other treatments and severity of the disease. Additionally, some agents may be contraindicated in patients with certain medical histories, such as a history of tuberculosis.

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.

Treatment for Fungal Nail Infection

Fungal nail infection is a common condition that affects many adults. If self-care measures and topical treatments are not successful or appropriate, treatment with an oral antifungal agent should be offered. The first-line treatment recommended is Terbinafine, which is effective against both dermatophytes and Candida species. On the other hand, ‘-azoles’ such as fluconazole do not have as much efficacy against dermatophytes. It is important to seek medical advice and follow the recommended treatment plan to effectively manage fungal nail infection. For further information, resources such as CKS Fungal nail infections, GP Notebook, and Patient.info can be consulted. The British Association of Dermatologists also provides guidelines for the treatment of onychomycosis.

Common Skin Disorders and Their Characteristics

Lichen planus is a skin disorder that has an unknown cause but is likely autoimmune. On the other hand, lichen sclerosus is characterized by itchy white spots that are commonly seen on the vulva of elderly women. Scabies, which typically affects children and young adults, causes widespread itching and linear burrows on finger sides, interdigital webs, and the flexor aspect of the wrist. Eczema usually presents as an itchy, red rash in the flexural areas, while psoriasis is characterized by itchy white or red patches on the extensor surfaces. These are some of the most common skin disorders and their distinct characteristics.

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.

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.

Surgical Margins for Skin Cancer Excision

When removing skin cancer through excision biopsy, it is important to use appropriate surgical margins to ensure complete removal of the cancerous cells. The size of the margin depends on the type and thickness of the cancer.

For melanomas, a 2 mm margin is used for the initial excision biopsy. After calculating the Breslow thickness, an additional wide excision is made with margins ranging from 1 cm to 2 cm, depending on the thickness of the melanoma. A 1 cm margin is used for melanomas measuring 1.0–4.0 mm, while a 2 cm margin is used for melanomas measuring >4 mm.

Squamous-cell carcinoma (SCC) requires a 4 mm excision margin, while basal-cell carcinoma (BCC) requires a 3 mm margin.

Using appropriate surgical margins is crucial for successful removal of skin cancer and preventing recurrence.

Investigating Pruritus in a Male Patient

Pruritus, or itching, can be a symptom of various underlying conditions. In the case of a male patient without apparent cause of pruritus, an HIV antibody test would be the most appropriate first-line investigation, along with other tests such as blood sugar, thyroid profile, and urea and electrolytes. This is because HIV infection can present with intractable pruritus before other symptoms appear. Allergen skin tests may be used in suspected allergic reactions, but they would be inappropriate in this case as there is no indication of such a reaction. The anti-M2 antibody test is used for primary biliary cirrhosis, which is a rare possibility in this case. A chest x-ray is not a useful first-line test as there is no indication of malignancy. Kidney diseases can give rise to pruritus, but there is no mention of kidney disease here. It is important to consider the patient’s medical history, including any potential risk factors such as IV drug abuse, which may be the source of infection. Further investigations may be necessary depending on the results of initial tests.

Treatment Options for Head Lice

Head lice infestations are a common problem, especially among children. There are several treatment options available, but not all of them are effective or recommended. Here are some of the commonly used treatments and their effectiveness:

Dimeticone 4% gel: This gel works by suffocating and coating the lice, making it a well-recognized treatment for head lice.

Ketoconazole shampoo: While this medicated shampoo is used to treat suspected fungal infections in the scalp, it is not a recognized treatment for head lice.

Permethrin 5% cream: Although permethrin is an insecticide used to treat scabies, it is not recommended for head lice treatment as the 10-minute contact time may not be enough for it to be effective.

Topical antibiotics: These are not recommended for head lice treatment.

Topical antifungal: Topical antifungals have no role in the management of head lice.

In conclusion, dimeticone 4% gel is a well-recognized treatment for head lice, while other treatments such as ketoconazole shampoo, permethrin 5% cream, topical antibiotics, and topical antifungal are not recommended. It is important to consult a healthcare professional for proper diagnosis and treatment of head lice.

Understanding the Side-Effects of Roaccutane®: Dry Skin and Lips

Roaccutane® is a powerful medication used to treat severe acne when other treatments have failed. While it is highly effective, it is also associated with a range of side-effects that patients should be aware of. One of the most common side-effects is severe dry skin and lips, which can be uncomfortable and require additional moisturizing. Other potential side-effects include dryness of the eyes, mucous membranes, and scalp, as well as muscle pain and hair loss.

It is important to note that Roaccutane® is highly teratogenic, meaning it can cause birth defects if taken during pregnancy. Women who are taking Roaccutane® should use at least two forms of contraception to prevent pregnancy. Additionally, all patients should have their liver function and lipid levels monitored before and during treatment, as Roaccutane® can cause elevated levels of both.

While night sweats and peptic ulceration are not recognised side-effects of Roaccutane®, photosensitivity is a potential side-effect, although it is not the most common. Weight gain is also not a recognised side-effect. Patients taking Roaccutane® should be aware of these potential side-effects and discuss any concerns with their healthcare provider.