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It’s This Rash Doc….
Richard de Ferrars
GP Programme Director
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Name and one Test
Xanthelasma – check lipids
Learning Point
You MUST understand primary & secondary preventionPrimary prevention – use risk scoringBut NOT if familial dyslipidaemia, diabetes
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What’s the Diagnosis & Management?
Trick questionMix of measles, Kawasaki & scarlet fever
Learning PointRash in child with fever:1) Think why is this NOT meningitis 2) Sick/ toxic – think and admit3) Eyes, mouth, lips funny - think
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Name and One Test
Butterfly rash (SLE) – anti-DNA antibodies
Learning PointImmunology blood tests are complex and full of false positivesAlways do esr/ crp first and never request immunology if esr/ crp normal
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Variations on a Theme
These all come from the same “cell line”
What is that cell line?
What is each a picture of?
All squamous cell – actinic (solar) keratosis, Bowen’s disease, keratoacanthoma, SCC
Learning Point:Look at old people’s hands and faces and start to form an idea of this spectrum
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Eczema Creams
Arrange these creams used in eczema in ascending potencyWhich are available OTC?
*Diprobase, *Hydrocortisone, *Eumovate, Betnovate, Dermovate
Learning Point:Know what you are using. DO NOT prescribe Eumovate generically
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Name and Treatment
Erythema Marginatum (Lyme Disease) - Doxycycline
Learning Point:Getting more common. Surrey is a hot-spotIf suspected – do paired serology as well as treating
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Moles – The Alphabet
Four are melanomas
One is a benign mole
What does ABCD stand for?
Asymmetry, border, colour, diameter
Learning point:Look at lots, ask lotsBEWARE “let me look again in 6-8 weeks”
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Name and Treatment
Pityriasis Rosea – Presumed viral, lasts 6-8w, no treatment
Learning point:Must remember as commonly brought to the GP
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Name and Treatment
Pityriasis Versicolor – Fungal (malasessia furfur). Anti-fungal (orally)
Learning Point:People who chose the names (diagnosis and cause) are having a laugh….
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It’s All Swollen Up…
Name the 3 conditions and your first treatment for each
Urticaria Angio-oedema Anaphylaxis
Anti-histamine Stop the ACE/ AT2 Panic?? Adrenaline?
Learning Points:AKT loves emergency drugs. Funny reaction – think drugs
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Name and Treament
Molluscum contangiosum – viral & no treatment – Wart virus infection
2 different conditions
Learning Point:If you start a treatment with low success-rate for a self-limiting & harmless condition you will only be making life difficult for yourself (or other GPs)….
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Four Types of Psoriasis
Name the four types shown and good first
treatment optionErythrodermicAdmit
PlaqueVit D analogue Flexural
Topical steroids
GuttatePUVA
Learning Point:Psoriasis is tricky to get rightDefinitely worth doing learning modules
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Four Blisters To Finish…
Pemphigoid Shingles
Pomphlyx HFM
Learning Point:Pemphigoid is the rarest cause of blistering rash!
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Learning Points
• Rash in child with fever– Think meningitis, think harder if eyes & mouth
• Look at lots of age changes AND ASK
• Look at lots of moles AND ASK
• If in doubt – ask!
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The End