A 41-year-old man develops itchy, polygonal, violaceous papules on the flexor aspect of his forearms. Some of these papules have coalesced to form plaques.
What is the most likely diagnosis?
Correct Answer A: Lichen
Lichen Planus:
Lichen planus is a skin disorder of unknown aetiology, most probably being immune mediated
Features:
Lichenoid drug eruptions - causes:
Management:
The basic lesion is a firm reddishviolet polygon. The surface, which has a sheen in oblique illumination, is covered with fine greyish striations known as Wickham's striae.
Papules may appear along the excoriations caused by scratching (Koebner's phenomenon).
A 30-year-old female in her third trimester of pregnancy mentions during an antenatal appointment that she has noticed an itchy rash around her umbilicus. This is her second pregnancy and she had no similar problems in her first pregnancy. Examination reveals blistering lesions in the peri-umbilical region and on her arms.
What is the likely diagnosis?
Correct Answer E: Polymorphic eruption of pregnancy is not associated with blistering. Pemphigoid gestationis is the correct answer. Polymorphic eruption of pregnancy is not associated with blistering.
Skin disorders associated with pregnancy:
1- Polymorphic eruption of pregnancy:
2- Pemphigoid gestationis:
Pemphigoid gestationis Erythematous urticarial and few tense vesicles, notice the periumbilical involvement.
A 62-year-old female is referred to dermatology due to a lesion over her shin. It initially started as a small red papule which later became a deep, red, necrotic ulcer with a violaceous border.
Correct Answer E: This is a classic description of Pyoderma Gangrenosum skin lesions.
The differential diagnosis of shin lesions includes the following conditions:
Below are the characteristic features:
Erythema nodosum:
Pretibial myxoedema:
Pyoderma gangrenosum:
Necrobiosis lipoidica diabeticorum:
Pyoderma gangrenosum The initial lesion is a rapidly enlarging hemorrhagic nonfollicular pustule surrounded by an erythematous halo and is very painful.
Pyoderma gangrenosum Lesions rapidly break down in the center and become boggy, hemorrhagic, and purulent ulcers.
A 39-year-old female has a pigmented mole removed from her leg which histology shows to be a malignant melanoma.
What is the single most important prognostic marker?
Correct Answer D: Melanoma: the invasion depth of the tumour is the single most important prognostic factor.
Malignant melanoma: prognostic factors:
The invasion depth of a tumour (Breslow depth) is the single most important factor in determining prognosis of patients with malignant melanoma.
Black, blue, grey and white in a malignant melanoma.
Halo phenomenon developing within a malignant melanoma that later proved fatal.
A 62-year-old female is referred due to a long-standing ulcer above the right medial malleolus. Ankle-brachial pressure index readings are as follows:
To date it has been managed by the District Nurse with standard dressings.
What is the most appropriate management to maximize the likelihood of the ulcer healing?
Correct Answer A: Management of venous ulceration - compression bandaging.
The ankle-brachial pressure index readings indicate a reasonable arterial supply and suggest the ulcers are venous in nature.
Venous ulceration: Venous ulceration is typically seen above the medial malleolus.
Investigations:
Venous Ulcer.
Same patient after few weeks of compression bandaging.