Skin disease

Published on 05/05/2015 by admin

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Last modified 22/04/2025

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23 Skin disease

Questions

Other than Staphylococcus aureus, which pathogens cause furuncles?

Can a skin disease, in particular a fungal disease, cause enlarged, tender lymph nodes?

In a 5-month-old baby with eczema:

1. What is the best treatment?

2. What is the prognosis?

3. What is the benefit of cleaning the affected areas with cold water?

Does psoriasis cause the formation of hypopigmented patches?

What is the suggested treatment for black spots on the face? What is the latest recommended treatment for acne?

1. Are there any side-effects from long-term use (2-3 months) of a topical antibiotic for acne vulgaris?

2. Is folliculitis related to the condition or the treatment in any way?

Is there a diagnostic test for acne rosacea? If intermittent facial flushing occurs on a regular basis, what other diagnosis might be reached?

Where can I find a model algorithm for the investigation of pruritus?

I would like to ask why moles form, particularly on the skin of the face. What is their non-surgical treatment?

In a patient with malignant melanoma, what do the following increasing values of thymidine kinase (mitotic index = 2) Breslow = 3; Clark = 4 predict?

What prognosis can be expected when a malignant melanoma is diagnosed with the results of Clark 4 and Breslow 3?

I have been wondering about the colouring of the skin in patients with haemochromatosis. You write ‘bronze skin pigmentation (due to melanin deposition)’, but I can’t understand where the increased melanin comes from? An increased production of melanin-stimulating hormone (MSH) doesn’t seem to fit in well with the decreased function of the gland regarding other hormones.

Please explain how to make a positive identification of vitiligo. I would be grateful if you could suggest further reading material for this condition.

Is there a common association between vitiligo and hypothyroidism?

Can a shagreen patch in tuberous sclerosis be bluish in colour?

What medical and minimally invasive therapy is available in Pakistan and in India for palmar hyperhidrosis?

Some people suffer with a non-hairy beard, others with fine and scanty hair. What treatment would you advise for both extremes?

Can alopecia universalis be due to psychological problems?

Can a negative serum ANA (antinuclear antibodies) exclude a diagnosis of systemic lupus erythematosus (SLE)?

Do patients with lupus cerebritis merit long-term antiepileptic drug treatment and has pulse cyclophosphamide a lesser incidence of side effects in this respect than daily cyclophosphamide, specifically a lesser incidence of haemorrhagic cystitis?

Is there a common association between vitiligo and hypothyroidism?

Staphylococcus aureus is the only common cause of furuncles.

1. Emollients to hydrate the skin. Topical steroids (low potency) are also helpful.

2. Good. It usually clears.

3. Better to use emollients (see K&C 7e, p. 1198).

Yes; particularly with topical treatment.

Nestle FO, Kaplan DH, Barker J (2009) Psoriasis. New England Journal of Medicine361: 496-509.

There are many causes of black spots, including the blackheads seen in acne. Treatment for mild to moderate acne is still topical, e.g. benzoyl peroxide, antibiotics, retinoids; with oral antibiotics for moderate/severe disease, e.g. minocycline 100 mg daily, or hormone treatment, e.g. co-cyprindiol in females. Very severe disease is treated with oral retinoids. These are teratogenic and their use is restricted to being supervised by a dermatologist.

1. Local irritation occurs but generally topical antibiotics are safe. Propionibacterium acnes-resistant strains occur.

2. Folliculitis is a pyoderma localized to hair follicles and is not related to acne.

No; it is a clinical diagnosis. The flushing may precede the other signs by a number of years.

This model is given in Fig. 23.1, which is derived from Table 23.10 on p. 1253 of Kumar and Clark Clinical Medicine 7th edn.

Fig. 23.1 Model algorithm for the investigation of pruritus. CXE, chest X-ray; FBC, full blood count; HIV, human immunodeficiency virus.

Moles can appear anywhere on the body, but just seem to be more prevalent on the face. There is no other treatment apart from removal. Cosmetic therapy can be tried.

Thymidine kinase is increased during DNA synthesis in cell proliferation. Increasing thickness is associated with increased recurrence: those with tumour less than 1 mm thick have an 80-90% 10-year survival. Increasing level of invasion (Clark’s level) and a high mitotic rate are poor prognostic factors.

Between 40 and 50% 10-year survival is a general figure. You need careful staging with TNM to accurately predict prognosis.

Further reading

Balch CM et al (2009) Melanoma staging and classification. In: Balch CM, Houghton AN, Sober AJ, et al. (eds) Cutaneous melanoma. St Louis, Quality Medical Publishing, pp. 65-86.

Bronze skin pigmentation is due to both iron and melanin deposition. It is not related to increased production of adrenocorticotrophic hormone or MSH.

Vitiligo is an acquired destruction of melanocytes giving white patches on the skin. The lesions are usually well defined and sometimes have a hyperpigmented margin.

Further reading

Taieb A, Picardo M (2009) Vitiligo. New England Journal of Medicine360: 160-169.

Vitiligo is considered to be an autoimmune disease involving melanocytes. It is associated with other autoimmune diseases such as autoimmune hepatitis and thyroid disease.

They are normally flesh coloured.

Alpha-adrenergic-blocking drugs such as phenoxybenzamine have been used, as has propantheline, with varying success. Injection of Botox directly into the palms reduces sweating but it is painful and expensive. Sympathetic denervation by resection of the 2nd thoracic sympathetic ganglion can be performed with minimal invasive surgery. Sweating is stopped initially but it returns.

In both cases, treatment is cosmetic.

The cause is unknown. Psychological problems have been implicated.

Serum ANA are present in 95% of cases of SLE so a negative result would make you cautious about making the diagnosis.

Cerebral lupus is treated with steroids and immunosuppression, e.g. cyclophosphamide. Pulse cyclophosphamide does seem to be associated with less haemorrhagic cystitis but it also seems to be less effective. (There are no good controlled trials.) Antiepileptic treatment would only be used if a flare-up in disease activity produces fits. Treatment would continue until the disease is inactive when cautious withdrawal would be reasonable.

Vitiligo is considered to be an autoimmune disease involving melanocytes. It is associated with other autoimmune diseases such as autoimmune hepatitis and thyroid disease.

Related

1000 Questions and Answers from Kumar _ Clarks Clinical Medicine