Hypertrichosis is the result of Porphyria cutanea tarda, not hirsutism.

Understanding Hirsutism and Hypertrichosis

Hirsutism is a term used to describe excessive hair growth in women that is dependent on androgens, while hypertrichosis refers to hair growth that is not androgen-dependent. Polycystic ovarian syndrome is the most common cause of hirsutism, but other factors such as Cushing’s syndrome, obesity, and certain medications can also contribute to this condition. To assess hirsutism, the Ferriman-Gallwey scoring system is often used, which assigns scores to nine different body areas. Management of hirsutism may involve weight loss, cosmetic techniques, or the use of oral contraceptive pills or topical medications.

Hypertrichosis, on the other hand, can be caused by a variety of factors such as certain medications, congenital conditions, and even anorexia nervosa. It is important to identify the underlying cause of excessive hair growth in order to determine the most appropriate treatment approach. By understanding the differences between hirsutism and hypertrichosis, individuals can better manage these conditions and improve their quality of life.

Urticaria is frequently observed as a result of aspirin, despite the fact that all medications have the potential to cause it.

Urticaria, also known as hives, can be caused by various drugs. Some of the most common drugs that can trigger urticaria include aspirin, penicillins, nonsteroidal anti-inflammatory drugs (NSAIDs), and opiates. These medications can cause an allergic reaction in some individuals, leading to the development of hives.

Antivirals can reduce the incidence of post-herpetic neuralgia in older people with shingles, but do not prevent the spread or recurrence of the condition. Analgesia should also be prescribed and bacterial superinfection is still possible.

Shingles is a painful blistering rash caused by reactivation of the varicella-zoster virus. It is more common in older individuals and those with immunosuppressive conditions. The diagnosis is usually clinical and management includes analgesia, antivirals, and reminding patients they are potentially infectious. Complications include post-herpetic neuralgia, herpes zoster ophthalmicus, and herpes zoster oticus. Antivirals should be used within 72 hours to reduce the incidence of post-herpetic neuralgia.

Based on the patient’s travel history to Afghanistan and the presence of a painless single lesion, the most probable diagnosis is cutaneous leishmaniasis. Although primary syphilis can also present with a painless lesion, the size and location of the lesion on the back of the hand is atypical. Pyoderma gangrenosum typically causes pain and presents more acutely. While a buruli ulcer can also present similarly, it is rare, mostly found in children, and has not been reported in the Middle East.

Source: WHO fact sheets on leishmaniasis
Cutaneous leishmaniasis is transmitted by sandflies and usually manifests as an erythematous patch or papule that gradually enlarges and becomes an ulcer with a raised indurated border. In dry forms, the lesion is crusted with a raised edge. It is usually painless unless a secondary bacterial infection is present. Afghanistan has particularly high levels of cutaneous leishmaniasis.

Leishmaniasis: A Disease Caused by Sandfly Bites

Leishmaniasis is a disease caused by the protozoa Leishmania, which are transmitted through the bites of sandflies. There are three main forms of the disease: cutaneous, mucocutaneous, and visceral. Cutaneous leishmaniasis is characterized by a crusted lesion at the site of the bite, which may be accompanied by an underlying ulcer. It is typically diagnosed through a punch biopsy from the edge of the lesion. Mucocutaneous leishmaniasis can spread to involve the mucosae of the nose, pharynx, and other areas. Visceral leishmaniasis, also known as kala-azar, is the most severe form of the disease and is characterized by fever, sweats, rigors, massive splenomegaly and hepatomegaly, poor appetite, weight loss, and grey skin. The gold standard for diagnosis is bone marrow or splenic aspirate. Treatment is necessary for cutaneous leishmaniasis acquired in South or Central America due to the risk of mucocutaneous leishmaniasis, while disease acquired in Africa or India can be managed more conservatively.

The acral-lentiginous melanoma is a subtype of melanoma that is often disregarded and not commonly seen in Caucasians. It is more prevalent in individuals from the Far East. This type of melanoma typically grows slowly and may not be noticeable in its early stages, presenting as pigmented patches on the sole. As it progresses, nodular areas may develop, indicating deeper growth. Sadly, the Jamaican musician Bob Marley passed away at the age of 36 due to complications from an acral lentiginous melanoma.

Malignant melanoma is a type of skin cancer that has four main subtypes: superficial spreading, nodular, lentigo maligna, and acral lentiginous. Nodular melanoma is the most aggressive, while the other forms spread more slowly. Superficial spreading melanoma typically affects young people on sun-exposed areas such as the arms, legs, back, and chest. Nodular melanoma appears as a red or black lump that bleeds or oozes and affects middle-aged people. Lentigo maligna affects chronically sun-exposed skin in older people, while acral lentiginous melanoma appears on nails, palms, or soles in people with darker skin pigmentation. Other rare forms of melanoma include desmoplastic melanoma, amelanotic melanoma, and melanoma arising in other parts of the body such as ocular melanoma.

The main diagnostic features of melanoma are changes in size, shape, and color. Secondary features include a diameter of 7mm or more, inflammation, oozing or bleeding, and altered sensation. Suspicious lesions should undergo excision biopsy, and the lesion should be completely removed to facilitate subsequent histopathological assessment. Once the diagnosis is confirmed, the pathology report should be reviewed to determine whether further re-excision of margins is required. The margins of excision are related to Breslow thickness, with lesions 0-1 mm thick requiring a margin of 1 cm, lesions 1-2 mm thick requiring a margin of 1-2 cm (depending on site and pathological features), lesions 2-4mm thick requiring a margin of 2-3 cm (depending on site and pathological features), and lesions over 4mm thick requiring a margin of 3 cm. Further treatments such as sentinel lymph node mapping, isolated limb perfusion, and block dissection of regional lymph node groups should be selectively applied.

Effective Treatments for Plantar Warts: A Guide

Plantar warts, also known as verrucas, are notoriously difficult to treat due to their thick cornified layer. This layer makes it harder for treatments to penetrate to the lower epidermis, resulting in lower cure rates compared to other skin warts. However, there are several effective treatments available.

First-line treatment for plantar warts is over-the-counter salicylic acid. While this treatment can turn the affected area white and cause soreness, it is often effective. Paring the wart before treatment may also help. Glutaraldehyde is another effective option, but it may turn the skin brown and cause sensitization.

Cryotherapy is a second-line treatment that involves freezing the wart with liquid nitrogen. However, multiple cycles may be needed for it to be effective. Reported cure rates vary widely.

For more aggressive treatment, salicylic acid and/or cryotherapy can be used with more intensive regimens. However, caution is needed as these treatments can have worse side effects.

Surgery and bleomycin are not typically used for plantar warts. Instead, the British Association of Dermatologists recommends several other treatments with some evidence base, including dithranol, 5-fluorouracil (5-FU), formaldehyde, laser, photodynamic therapy, topical immunotherapy, and podophyllotoxin.

In conclusion, while plantar warts can be challenging to treat, there are several effective options available. Consult with a healthcare professional to determine the best course of treatment for your individual case.

Urgent Referral Needed for Suspicious Lesion

This patient’s lesion is highly suspicious of a melanoma and requires immediate referral to a dermatologist. Any delay in monitoring in primary care could result in delayed treatment and potentially worse outcomes. The lesion’s recent increase in size, irregular pigmentation, and margin are all factors that raise suspicions. To aid in decision-making, the 7-point weighted checklist can be used, which includes major features such as change in size, irregular shape, and irregular color, as well as minor features like inflammation, oozing, change in sensation, and largest diameter 7 mm or more. Lesions scoring 3 or more points are considered suspicious and should be referred, even if the score is less than 3. If the lesion were low risk, it would be reasonable to monitor over an eight-week period using the 7-point checklist, photographs, and a marker scale and/or ruler. However, it is not appropriate to excise or biopsy suspicious pigmented lesions in primary care.

Referral for oral retinoin is recommended for patients with scarring.

Acne vulgaris is a common skin condition that usually affects teenagers and is characterized by the obstruction of hair follicles with keratin plugs, resulting in comedones, inflammation, and pustules. The severity of acne can be classified as mild, moderate, or severe, depending on the number and type of lesions present. Treatment for acne typically involves a step-up approach, starting with single topical therapy and progressing to combination therapy or oral antibiotics if necessary. Tetracyclines are commonly used but should be avoided in certain populations, and a topical retinoid or benzoyl peroxide should always be co-prescribed to reduce the risk of antibiotic resistance. Combined oral contraceptives can also be used in women, and oral isotretinoin is reserved for severe cases under specialist supervision. Dietary modification has no role in the management of acne.

Management of Recurrent Herpes Labialis: Treatment Options and Diagnostic Considerations

Recurrent herpes labialis, commonly known as cold sores, can be a frustrating and uncomfortable condition for patients. Here are some management options to consider:

– Oral antivirals: Treatment with oral antivirals may be considered in healthy patients if the lesions are persistent. Treatment should be started at the onset of the prodrome until the lesions have healed.
– Topical aciclovir: While topical aciclovir can be used intermittently when prodromal symptoms appear, it is not recommended for long-term prophylaxis.
– Sun protection: Sun exposure can trigger facial herpes simplex, so sun protection using a high-protection-factor sunscreen and other measures may be tried.
– Laser therapy: There is no evidence to support laser therapy in the management of recurrent herpes labialis.
– Diagnostic considerations: Investigations are not usually necessary in primary care to confirm the diagnosis. Tests for underlying immunosuppression may be considered with persistent or severe episodes.

It is important to work with patients to find the best management plan for their individual needs.

Understanding Scabies: Symptoms and Treatment

Scabies is a highly contagious disease caused by the mite Sarcoptes scabiei, which is commonly found in sexually active individuals. The disease is characterized by generalised pruritus, and it is important to carefully examine the finger spaces for burrows.

The most effective treatments for scabies include permethrin cream, topical benzyl benzoate, and malathion. While permethrin cream doesn’t directly alleviate pruritus, it helps to kill the mite, which is the root cause of the disease. Patients should be advised that it may take some time for the itching to subside as the allergic reaction to the mite abates. Additionally, it is important to apply the cream to all areas below the neck, not just where the rash is present.

In summary, scabies is a highly contagious disease that can cause significant discomfort. However, with proper treatment and care, patients can effectively manage their symptoms and prevent the spread of the disease.