Check Study Program

#Week9_Case4

Tobias, a man aged 40 years, attends your general practice reporting whitening of the skin on his hands (Figure 1) and forearms that has become more prominent over the summer months. He works as a salesman. He is Fitzpatrick skin type 3. 1.What key points from his history, examination and relevant symptoms would you specifically ask about? 2.What key points in the history would aid the formulation of your primary diagnosis and exclusion of potential differentials? 3.What tests would you need to perform? 4.What would you expect when using a Wood’s lamp to evaluate Tobias’s skin? 5.What is the final diagnosis for Tobias? 6.What steps would you take in primary care to manage his case? 7.What other medical or surgical treatments are available from a non–general practitioner specialist? 8.What features in Tobias’s history suggest poor prognostic outcomes with regards to his vitiligo, and what other comorbidities can be associated with vitiligo? #Week9_Case4

#Acne_Etiology

#Acne_Isotrretinoin

#Acne_Isotretinoin_Side_Effects

#Acne_Diet

#Acne_Spironolacton

#Acne_Hormonal_Treatment

Antibiotic treatment should be limited to 3–6 months’ duration and be combined with topical benzoyl peroxide (BPO) and/or a retinoid to reduce the risk of antibiotic resistance. Medium- term oral antibiotic options include macrolides (erythromycin) and tetracyclines (doxycycline, minocycline). These antibiotics have both anti-inflammatory and antibiotic effects on acne. Trimethoprim/sulfamethoxazole, cephalosporins and penicillins may be used but are less effective for acne. Adverse effects of antibiotics occasionally limit their use. Vaginal candidiasis and drug eruptions may occur with any antibiotic. Erythromycin is associated with gastrointestinal disturbance and rarely causes cardiac conduction abnormality and hepatotoxicity. Tetracyclines may cause photosensitivity and liver derangement. Doxycycline can cause gastrointestinal disturbance, in particular reflux. Minocycline is associated with tinnitus, dizziness and pigment deposition in the skin, particularly with longer courses. #Acne_Antibiotics

#Acne_Topical_Treatments

#Acne_Psychological_Impact

#Acne_Index

Information to ask about in the patient’s history includes: • How much does the acne bother her? Does it limit her activities? Does it affect her mood? • What past and present acne treatments does she use? This includes over-the-counter, beautician-recommended and prescription treatments. • Does she ever drink protein shakes or take anabolic steroids or other supplements? • Does she have any signs and symptoms of PCOS or hyperandrogenism including menstrual irregularities, hair thinning, weight loss or gain, adult-onset acne, hirsuitism, history of miscarriage or difficulty falling pregnant? • What other medical problems (including dermatological) does she have? • Is there a family history of acne? • What work and hobbies does she do? What is her social history? Include any features that may exacerbate acne or may affect treatment options (eg working in hot environments, sun exposure, alcohol intake). • Is she on any contraception? Is she sexually active? Does she have plans for pregnancy in the near future? • What are her goals for treatment? For example, does she have an important social event for which she would like clear skin? • Is she a smoker? • Does she have any fevers, arthralgia or bone pain? This may suggest acne fulminans or synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome requiring urgent dermatology referral. #Acne_History

#Week9_Case3_Acne

Xanthe, aged 30 years, presents with concerns about her acne (Figure 1). She reports mild acne as a teen, which became more severe in her early twenties when she ceased her contraceptive pill. Xanthe currently uses a 2% salicylic acid cleanser and gentle moisturiser. She took doxycycline for six months last year with only mild improvement. 1.What else would you like to know about Xanthe’s history? 2.How would you assess acne severity? 3.What investigations would you consider? 4.What are the diagnostic criteria for polycystic ovary syndrome (PCOS)? What are the other causes of hyperandrogenism? 5.What are the differential diagnoses for acne in adults? 6.What are the treatment options? 7.What are the dietary considerations for acne? 8.What are the common side effects of isotretinoin? 9.What is the typical course of treatment for isotretinoin? #Week9_Case3

#Nail_Psoriasis_Mx_eTG

#Onychomycosis_Treatment_eTG