Rashes in Creases

Question 1

What is a good algorithm for symmetrical rashes in creases?

Answer 1

Question 2

What is a good algorithm for asymmetrical rashes in creases?

Answer 2

Question 3

What is a good algorithm for flexural rashes in that are pigmented or skin coloured?

Answer 3

Question 4

Why must one be careful when using steroids on flexural sites?

Answer 4

They have a natural occlusive effect making the steroid more potent.

Question 5

What is thought to be the cause for seborrheic eczema/dermatitis?

Answer 5

Malassezia furfur

Question 6

What is the treatment for Scalp Seborrheic Eczema/Dermatitis?

Answer 6

• Overnight application of olive oil
• Low potency topical steroids - apply for a few hours for thicker crusts. (SEBCO ointment)
• Ketoconazole shampoo (leave on for 5 minutes)
  
  • Initiation: 2-3 times weekly until clear
  • Maintenance: Once every 2 weeks.
• FOR ITCH: steroid mouse, gel or lotion 2-3 times per week at night for 2-4 weeks. (e.g. Betnovate)

Question 7

What is the treatment for Adult Seborrheic Dermatitis/Eczema on the skin?

Answer 7

1. Ketoconazole shampoo as a bodywash.
   
   • Leave on for 5 minutes. Use 3 times weekly for 2 weeks and then as required.
2. Topical Anti-fungals- Miconazole, Clotrimazole, Ketoconazole.
3. ITCH
   
   • Mild to moderate potency steroids - Eumovate
   • Comabined steroid/Antifungal - Daktacort/Resolve Plus.
4. Calcineurin inhibitors - Pimecrolimus or Tacrolimus for flares and resistant cases.

Question 8

Is the treatment for Seborrheic Dermatits/Eczema curative or to control?

Answer 8

To Control

It is not curable.

Question 9

What is the treatment for Recalcitract Seborrheic Eczema/Dermatitis?

What should you also investigate for?

Answer 9

Oral Itraconazole 200mg Once daily for 7 days

Consider Ix for HIV

Question 10

What is the treatment for infantile seorrheic eczema?

Answer 10

• Emollients
• Mild topical corticosteroids
• Steroid+ Antifungals can be used - rarely needed.

Question 11

What is this?

Answer 11

Infantile Eczema

(Lack of satellite lesions & the fact that it flows together makes it more likely to be eczema)

Question 12

If a case of infantile eczema or tinea doesn’t clear, what should you consider as a differential diagnosis?

Answer 12

Langerhan’s Cell Histiocytosis

• Accumulation of abnormal histiocytes in the skin and reticuloendothelial system.
• Yellow brown papules.
• Scalp often affected.
• Often have bone pains/bone lumps.

Question 13

What is this?

Answer 13

Contact dermatitis

Question 14

What is this?

Answer 14

Flexural psoriasis

Question 15

What are 3 causes of intertrigo?

Answer 15

1. Red skin from 2 moist surfaces rubbing together
2. Cutaneous candidiasis
3. Seborrhoeic eczema

Question 16

What is the treatment of flexural psoriasis?

Answer 16

Generally resistant

• Hygeine measures
• Vitamin D Analogues - test patch first as it might irritate.
• Combined topical steroids/antifungal
• Calcineurin Inhibitors

Question 17

What is the cause of erythrasma?

Answer 17

Corynebacterium Minutissimum

Question 18

What colour does Erythrasma (Corynebacterium) go under a wood’s light?

Answer 18

Orange

Question 19

What is the treatment for Erythrasma?

Answer 19

• Antibacterial washes
• Topicals - clindamycin & Fusidic acid.
• Resistant - oral erythromycin or doxycycline.

Question 20

What is this?

Answer 20

Tinea Cruris

(Raised erythematous scaly border)

Satellite lesions are NOT seen unlike in Candidiasis.

Question 21

What is this?

Answer 21

Candida infection

(Satelite lesions in candida infection)

Question 22

What is the treatment for candida infection?

Answer 22

• General hygiene and keep dry.
• Clotrimazole cream
• For severe cases oral itraconazole may be required.

Question 23

What is the treatment for tinea cruris?

Answer 23

• Keep dry
• Clotrimazole cream twice daily for 2-3 weeks.
• Oral terbinafine can also be used for 2-3 weeks if needed.

Question 24

What is the treatment for acanthosis nigricans?

Answer 24

• Topical retinoid - Tazarotene gel
• Pigmanorm - Hydroquionone + RetinA + Hydrocortisone.

The above will not get rid of it but can help lighten the pigmentation.

Question 25

What is this rare genetic disease of blisters in teh groin?

Answer 25

**Hailey-Hailey Disease** * **Erythematous plaques** and **flaccid blisters** on the **neck** and **intertrigenous areas**. * **Diagnosis** - **skin biopsy** with **Direct IMF**. * **H&E histology** is very similar to pemphigus vulgaris or Darius Disease. * **IMF** is usually **negative**. * **Treatment**: * Topical **antibacterials** and **antifungal agents**. * Mild/moderate strength **topical steroids** are the mainstay of treatment. * **CO2 Laser**. * **Topical Metronidazole** is good for **malodorous** cases.

Question 26

Hidradenitis Suppuritiva is a disease of what?

Answer 26

Of the apocrine sweat glands.

Question 27

HS is more common in which gender?

Answer 27

Women

Question 28

What is the staging system for HS?

Answer 28

**The Hurley Staging System** * **Hurley I: abscess formation** (single or multiple) w/o sinus tracts * **Hurley II:** one or more widely **separated recurrent abscesses** with tract formation and scars * **Hurley III:** multiple **interconnected tracts** and abscesses throughout an **entire area**

Question 29

What is the treatment for HS?

Answer 29

1. **Conservative** - weight reduction, smoking cessation. 2. **Mild Disease** - * **Clindamycin BD Topical** * **Chlorhexidine washes**. 3. **Moderate Disease** * **1st line -** **Erythromycin**/Doxycycline or Lymecycline * **2nd line** - **Rifampicin** and **Clindamycin** * Use for **3-6 months**. Monitor LFTs with Rifampicin. Don't use rifampicine alone. 4. **Adjuncts** * **Yasmin** - antiandrogen. * Systemic **retinoids**. * **Botox** 5. **Severe Disease** * **Immunosuppression** - ciclosporin, Adalimumab. * Surgery

Question 30

What is the treatment for axillary hyperhydrosis?

Answer 30

* **Antiperspirant** - topical 20% aluminium chloride hexahydrate (**Driclor**). * **Topical** **antichlorinergics** - **topical glycopyrrolate**. * **Oral therapies** * **Oxybutnin** 10mg at night. * **Propantheline** 15-90mg daily. * **Botulinum Toxin A** - 15-20 injections to the axillae. * **Iontophoresis** - electrical current. Machines can be bought. * **Surgical** removal of the sweat glands.

Question 31

What is this?

Answer 31

Iontophoresis