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Managing patients with hidradenitis suppurativa

23 May 2016Paid-up subscribers

Hidradenitis suppurativa affects the apocrine-bearing areas of the skin. The onset is variable but usually occurs in the second and third decades of life, coinciding with development of the apocrine glands. The condition is characterised by painful, inflammatory papules and nodules which frequently progress to form abscesses, sinus tracts and hypertrophic scars.The most important non-genetic factors implicated in hidradenitis suppurativa are obesity and smoking.

Tailor systemic therapy to the patient with severe psoriasis

22 Feb 2016Paid-up subscribers

There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile.

Diagnosis directs treatment in fungal infections of the skin

21 Oct 2015Registered users

Dermatophyte fungi are confined to the keratin layer of the epidermis and include three genera: Microsporum, Epidermophyton and Trichophyton. These infections can be transmitted by human contact (anthropophilic), from the soil (geophilic) and by animal (zoophilic) spread. Dermatophyte infections usually present as an erythematous, scaly eruption, which may or may not be itchy. Asymmetry is an important clinical clue to fungal infection, as is annular morphology.

Improving detection of non-melanoma skin cancer

05 Aug 2015

Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are clinically and pathologically distinct and both are locally invasive. However, while BCCs rarely metastasise, SCCs have the potential to do so especially when they arise on the ears or lips. Patients with one non-melanoma skin cancer (NMSC) have a higher risk of developing another NMSC and of malignant melanoma.

Managing urticaria in primary care

23 Feb 2015Paid-up subscribers

Urticaria is characterised by transient wheals that consist of a swollen palpable centre often surrounded by an erythematous flare, associated with itching or, less commonly, a burning sensation. Individual wheals usually disappear within 1 to 24 hours leaving normal skin. The prognosis for eventual recovery from spontaneous and inducible urticaria is excellent. However, the time course is unpredictable and may extend to years, often following a relapsing and remitting course.

Improving the management of rosacea in primary care

23 Oct 2014Registered users

Rosacea is more common in women than men and occurs more frequently in fair-skinned individuals, usually in the middle years of life. It tends to localise to the cheeks, forehead, chin and nose, sometimes showing marked asymmetry. Only very occasionally does it involve areas other than the face. Important distinguishing features from acne are a lack of comedones, absence of involvement of extra-facial areas, and the presence of flushing. Rosacea is a disfiguring condition that can have a major psychosocial impact, and its detrimental effect on emotional health and quality of life is often overlooked.

Identifying the causes of contact dermatitis

23 Jun 2014Paid-up subscribers

Contact dermatitis results from skin contact with an exogenous substance. It can be caused by direct contact, airborne particles, vapours or light. Individuals of any age can be affected. The two most common variants are irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ICD is more common and has a worse prognosis. ICD is a form of eczema and is induced by direct inflammatory pathways without prior sensitisation. If eczema is recurrent/persistent, or occurs in an individual with no previous history of eczema, contact dermatitis should be considered. If ACD is suspected the patient should be referred to secondary care for patch testing.

Improving the management of seborrhoeic dermatitis

24 Feb 2014Paid-up subscribers

Seborrhoeic dermatitis usually starts at puberty with a peak incidence at 40 years of age and is more common in males. Patients develop symmetrical, well demarcated, dull or yellowish red patches and plaques with overlying adherent, yellowish greasy scales. Seborrhoeic dermatitis has a distinctive distribution in areas rich in sebaceous glands. Patients presenting with sudden onset severe seborrhoeic dermatitis should be screened for risk factors for HIV.

Alopecia areata: more than skin deep

23 Sep 2013Paid-up subscribers

Alopecia areata is a chronic inflammatory non-scarring condition affecting the hair follicle that leads to hair loss ranging from small well defined patches to complete loss of all body hair. The severity of hair loss at presentation appears to be the strongest predictor of long-term outcome. Individuals with alopecia areata should be referred for dermatological advice if there is diagnostic uncertainty, they have extensive hair loss, they are suffering severe psychological distress or they would like a wig.

GPs have key role in early detection of melanoma

24 Jun 2013Registered users

Lesions which have a high index of suspicion for melanoma should not be removed in primary care. Patients should be referred urgently to secondary care with a history recording the duration of the lesion, change in size, colour, shape and symptoms.  [With external links to current evidence and summaries]

Intense nocturnal itching should raise suspicion of scabies

23 May 2013Paid-up subscribers

Scabies is spread by a mite transferring to the skin surface of an unaffected person, usually by skin to skin contact with an infested person, but occasionally via contaminated bed linen, clothes or towels. Patients with classical scabies usually present with an itchy non-specific rash. Often, the history alone can be virtually diagnostic. An intense itch, affecting all body regions except the head, typically worse at night, appearing to be out of proportion to the physical evidence, with a close contact also itching, should prompt serious consideration of scabies. The crusted variant of scabies may not be itchy. It is characterised by areas of dry, scaly, hyperkeratotic and crusted skin, particularly on the extremities.

Improving outcomes in patients with psoriasis

24 Jan 2013Paid-up subscribers

The majority of patients with psoriasis can be managed in primary care, although specialist care may be necessary at some point in up to 60% of cases. Patients with erythrodermic or generalised pustular psoriasis should be referred for a same day dermatological opinion, and if psoriatic arthritis is suspected, early referral for a rheumatological opinion is recommended. Recent guidance from NICE and SIGN will contribute significantly to the care of psoriasis sufferers in both primary and secondary care. [With external links to the evidence base]

Be vigilant for scurvy in high-risk groups

24 Oct 2012Paid-up subscribers

Scurvy is a disabling, potentially fatal, but entirely treatable, condition that can easily pass unrecognised. It has by no means been confined to the history books, even in affluent cultures, and vitamin C deficiency appears to be relatively common in the UK, particularly in those living on a low income. The occurrence of a macular purpuric eruption on the legs should always prompt consideration of the diagnosis of scurvy, especially in those at risk.

Prompt treatment of acne improves quality of life

20 Jun 2012Paid-up subscribers

Acne vulgaris is an inflammatory disorder of the pilosebaceous (hair follicle) units. It is very common, affecting 90% of teenagers, albeit often mildly. However, its onset may be delayed until the late twenties or early thirties, and very occasionally even later. In the majority of cases, acne settles by the mid-twenties, but for some patients it may still be problematic in their forties and beyond. Patients should be referred to a dermatologist if they have: a very severe variant; severe social or psychological problems; risk of scarring; failed to respond to treatment or are suspected of having an underlying endocrinological cause. [With external links to the evidence base]

Improving the management of atopic eczema in primary care

25 Apr 2012Paid-up subscribers

Although generally considered a childhood ailment, 38% of patients with atopic eczema in the UK are adults. The condition often has a significant detrimental effect on the quality of life of affected individuals and their families. Despite national evidence-based guidelines in the UK, standards of care in the community setting can vary. Patients or carers should receive a full explanation of how to use topical treatments and a demonstration of how to apply dressings, if applicable. [With external links to the evidence base]

Improving recognition of psoriatic arthritis

17 Dec 2009Registered users

 Psoriatic arthritis (PsA) is a common form of inflammatory arthritis but is underdiagnosed. Psoriasis affects more than 1.5% of the UK population so a GP with an average list size is likely to care for around 40 patients with psoriasis. Around 15% of these patients will be diagnosed with PsA, but up to 40% of them may have evidence of arthritis if reviewed thoroughly. [With external links to the evidence base]

 

Photoguide

Papulosquamous conditions

23 Sep 2016Registered users

• Pityriasis rosea • Discoid lupus erythematosus • Lichen planus • Seborrhoeic dermatitis • Tinea corporis • Plaque psoriasis

Sun damage

23 Jun 2016Registered users

 • Squamous cell carcinoma • Actinic keratosis horn • Bowen’s disease • Solar elastosis • Rosacea • Discoid lupus

Conditions affecting the hair and scalp

25 Apr 2016Registered users

• Dermatitis artefacta • Alopecia mucinosa • Lichen planopilaris • Discoid lupus erythematosus • Sebaceous naevus • Basal cell carcinoma

Fungal infections

21 Mar 2016Registered users

• Lingua villosa nigra • Onychomycosis • Tinea corporis • Tinea pedis • Id reaction • Tinea incognito

Inherited disorders

22 Feb 2016Registered users

• Darier’s disease • Diffuse palmoplantar keratoderma • Familial hypercholesterolaemia • Neurofibromatosis type 1 • Haemophilia A • Epidermolysis bullosa simplex

Skin conditions in children

25 Jan 2016Registered users

 • Classic spitz naevus •  Irritant saliva dermatitis •  Umbilical granuloma •  Cradle cap •  Molluscum contagiosum •  Juvenile plantar dermatosis

End of year photo quiz - 2015

22 Dec 2015Registered users

Test your diagnostic skills

Urgent referral for skin lesions

25 Nov 2015Registered users

• Anaplastic large-cell lymphoma • Bullous pemphigoid • Malignant melanoma • Squamous cell carcinoma • Gangrene • Necrotising fasciitis

Photoguide: Pigmentation disorders

21 Oct 2015Registered users

Vitiligo • Melanonychia • Pigmented basal cell carcinoma • Haemosiderin deposition • Blue naevus • Lead pellet

Allergic reactions

24 Sep 2015Registered users

• Fixed drug eruption • Fabric plaster reaction • Latex allergy • Morbilliform drug reaction • Allergic conjunctivitis • Anaphylaxis

 

Online only

Special interest: Dermatology 2 - 2013

13 Jan 2014Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

  • Alopecia areata:more than skin deep
  • GPs have key role in early detection of melanoma
  • Intense nocturnal itching should raise suspicion of scabies
  • Improving outcomes in patients with psoriasis

Special Interest - Dermatology 1: 2012-Jan2013

07 Feb 2013Paid-up subscribers

This PDF pack can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer.

  • Improving the management of atopic eczema in primary care
  • Prompt treatment of acne improves quality of life
  • Be vigilant for scurvy in high-risk groups
  • Improving outcomes in patients with psoriasis

The monthly photoguide series is not included in this PDF pack. These articles can be accessed from the website under 'photoguide'