What is your diagnosis?

 

Dermatology Dissertation (Thesis)

Dermatology Post Graduate Dissertation

Finding a dissertation topic is every post graduates nightmare. Many of them believe that most of the common skin conditions are extensively studied. Hence they either try to concentrate on rare disorders or repeat a study in a different way. However resources on evidence based Dermatology show that lacunae exist in the management of even common skin conditions.

Let me Quote from Williams Hywel (Editor). Evidence based dermatology: BMJ Publishing Group. 2003. on Hand Dermatitis.

The choice for an optimal topical steroid treatment schedule cannot be derived from current literature on hand eczema trials. Evidence from studies on other eczematous diseases has to be considered. However 6 RCTs were available for ionizing radiation v/s topical steroids. Does the daily application of a bland emollient lead to dose and/or frequency reduction of topical corticosteroids in adults with chronic hand eczema? No RCT addressing this issue could be identified.

I highly recommend this book for dermatology post graduates looking for a dissertation topic.

--

A 50 year old male with multiple lesions over both extremities since 3 weeks.

 

Penile Lesions

A young man in his late twenties came to me for the treatment of his hand dermatitis. He said he also had some penile lesions which is present since childhood and it bleeds on scratching sometimes. He said his father and his grandfather had similar lesions! What is your diagnosis?

 

What is your diagnosis?

A 40 year old male patient with this bilateral rash with itching, extending to ears since 5 days. What is your diagnosis? 

Diagnosis

A male patient in his early twenties presented with this hand lesion since 3 months and the neck lesion since 4 years. What is your diagnosis?

 

Notes from BJD Jan 2006

Notes from BJD Jan 2006 154(1) Part - I
Today I got the last of three free issues of BJD with a hand written note from the publisher. There was no personal email ID. I wish to Thank Mr Phil Wright (Senior Marketing Manager, Blackwell Publishing Ltd) for sending me copies of BJD. Hope this page shows up on his name search sometime.
I was never interested in animal models in dermatology. Rabbit ear (comedones) and nude mice (Leprosy) were my professor’s favorites. Today I read about NC/Nga mouse model for Atopic Dermatitis. I never thought it will be possible to come out with an animal model for such a complex disorder like Atopic Dermatitis. I also read about Acquired bilateral naevus of Ota like macules or Hori naevus common in women. The name aptly describes the condition. A study of PUPPP (181 patients) documented its two phased presentation. Initial urticarial response and later vesicular - eczematous response.
I will post notes on the rest of the articles later. Now over to some bimatics blogging.
I was reading about the use of niacinamide in BP and CP. Local niacinamide is available here. Will it be useful for the above conditions?

Candidial Paronychia

Candidial paronychia is common in females as prolongued water exposure is the main causative factor. This patient was male nevertheless same risk factors were present as he is a juice shop worker. Nail involvement of characteristic of this condition and a mixed bacterial infection is almost always present. I read an article about the role of immediate contact dermatitis to food allergens (?protein contact dermatitis) in the pathogenesis which I was not aware. What are the implications of this new finding in its treatment? If there is progression to total nail dystrophy Cushings and Raynauds need to be ruled out.

 

My wife astonishes me

This is the case I posted few days back. Today while going through my Blog my wife asked me.

Is this the same case you missed for your exam in Glasgow? Some Lupus or something.....

After nearly 10 years of dermatology training and publishing a study of treatment options in SLE in nearly 80 patients, I failed to consider papulosquamous SCLE in this patient with psoriasiform lesions over exposed areas while my wife from computer field with zero dermatology training did so! I guess that is how life is. I write better java, php and VB code than her with zero training (smile).

I will investigate him further when he comes next time.

The story of how I missed SCLE for my exam in Glasgow, I will post later.

 

Pigmentation

Today a 34 year old male patient came to me with this well demarcated pigmentation over the neck extending to the face since 3 months. He also had few pigmented streaks over both arms. What are the differential diagnosis?

 

Picture 1

A 43 year old male patient presented to me with 3 month history of excoriated vesicles and urticarial lesions over the shoulders and upper back. Mild to moderate pruritus was present.

 

Picture 2

He had this single tense blister on an erythematous base on his left leg.

Picture 3

His Oral mucosa had this lesion. What is your diagnosis?

 

Riehl's melanosis

Riehl's melanosis, now synonymous with pigmented contact dermatitis is an entity, not probably studied extensively. It is more common in people with dark complexion and sensitizing chemicals in cosmetics are incriminated. It was common in Europe during world war II and the incidence reduced with the end of the war.
However this is a very common problem in South Indian and the expatriate population in Gulf. In this region it is more common in males. Due to its prediliction for forehead just above the eyebrows, some of us call it seborrhoeic melanosis atributing it to post inflammatory hyperpigmentation due to seborrhoic dermatitis.
If anybody is interested in joining me for a multicentric study of this condition, please contact me.

 

What is your diagnosis?

A 23 year old male patient presented with erythematous scaly rash over the arms neck and back. Itching is mild to moderate. He had scaling of scalp also. According to him he has been getting recurrant lesions like this for past few years. Diagnosed by someone else as psoriasis. No significant drug history. What is your diagnosis?

 

Pic 2: Neck

 

Pic 3: Arms

 

Primary Herpetic GingivoStomatitis.

My diagnosis is Primary Herpetic GingivoStomatitis. Details including DDs like ANUG are available here.

Hi All

Hi All
Blog or weblog is a kind of online diary which everybody can read and post comments. However I do not intend to maintain this as a personal diary. If we can make this a common forum for all of us to post interesting cases it will be very useful and interesting. We have Shruti Madam as a very active member of this blog and we can all benefit from her experience. I have sent invitations to all with a valid email address but only 2 have responded so far. Once you are a member you can post pictures and cases to the blog and not just comments (For which you do not need membership).
Posting a case on this blog is as simple as clicking a button. You need to download free software called Picasa from http://picasa.google.com/ . If you know me personally and want to join this Blog as a contributor please contact me.
Finally a word of caution to all existing contributors. Please remember that this is a public forum accessible to everyone on the internet. Hence take maximum care to mask the identity of the patient in the picture (and please DO NOT include any personal details in the text). Sometimes a black band across the eyes may not mask the identity adequately. If you are not sure how to mask the identity, please mail the photo to me before posting it on the blog.

Please note that only recent posts will be available on this page. Links to the archives are available on the left menu.
Regards & Happy Blogging
Bell

Phototesting

Phototesting.
I read an article about phototesting in PLE (BJD 2005 153, 1234) by Prof. Schornagel from Utrecht, Netherlands. Authors conclude that

• Optimum number of exposures for phototesting is 4


• Oberving skin reactions for a few days after discontinuation of phototesting can be informative.

Phototesting was +ve in 38 out of 40 suspected cases of PLE. When I was in Manipal, India as a post graduate, we have not succeeded in demonstrating even a single +ve response on phototesting! What could be the reason? Bad technique or dark Indian skin?

Pityriasis Rosea

A nice case of PR.

 

Diagnosis?

What is your diagnosis?

 

Naevus Flammeus

Today this girl walked into my consultation room with a lollypop in her hand as a visitor (Not as a patient). I noticed this patch of naevus flammeus on her forehead close to the eye with a sharp midline cut off. As her parents were not with her I could not elicit a history. She probably needs an opthalmic consultation as it is close to the eye. There was no gross neurological findings. 

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Diagnosis?

A 34 year old man with this solitary annular lesion over the left thigh since 6 months. What is your diagnosis? 

Delusion of Parasitosis

Delusion of Parasitosis
Today a patient came to me with the typical history of Delusion of Parasitosis. He thinks that his middle ear cavity is infested with insects. He has already consulted many Dermatologists and ENT surgeons. Many of them have suggested psychiatric evaluation which the patient has vehemently declined. Textbooks say that the doctor should take a neutral stand neither accepting his delusion thereby reinforcing it nor out rightly rejecting the delusion which will antagonize the patient. I wrote the diagnosis down on a piece of paper and told him to go to the internet and study about the condition. If he returns to me, I will refer him to a psychiatrist. Drugs like pimozide are controlled in this country. It is difficult for a dermatologist to start such medications.

Rosacea

Rosacea is relatively common here! A very popular brand of condensed milk available here is often responsible for flushing and rosacea like skin changes on long term use. I have experienced the flushing after drinking this milk myself! Milk is as harmful as alcohol here. 

January 2006

Click here to see last months’ cases