By Rachael Morris-Jones
A 23-year-old African Caribbean girl provides within the emergency division with an acute onset facial rash. in the course of preliminary review she complains of a week background of basic malaise, fatigue, fever, and weight-loss. you've been assigned her examination...
100 instances in Dermatology offers a hundred eventualities with a dermatological manifestation ordinarily noticeable via scientific scholars and junior medical professionals. A succinct precis of the patient's background, exam and preliminary investigations, together with complete color photos displaying presentation, is through questions about the analysis and administration of every case. the reply incorporates a distinctive dialogue on every one subject, with extra representation the place applicable, delivering a vital revision relief in addition to a realistic consultant for college kids and junior doctors.
Making scientific judgements and selecting the simplest plan of action is without doubt one of the such a lot demanding and tough components of educating to develop into a physician. those instances will educate scholars and junior medical professionals to acknowledge very important dermatological signs and indicators and, the place applicable, their dating to different health conditions, and to boost their diagnostic and administration skills.
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Extra resources for 100 Cases in Dermatology
Sudden-onset widespread rashes are usually ‘reactive’ with the two most common underlying causes being ‘drugs or bugs’. The key to identifying the culprit drug is the taking of a detailed history of the patient’s medications and the time course over which each was started in relation to the onset of the rash. In this case the drug responsible is penicillin. If possible, the culprit drug should be stopped; however, if the drug is vital for the patient’s underlying condition then toxic erythema can be managed with a moderately potent topical steroid and emollients.
Intermittently she has developed new lesions in addition to the old lesions flaring. She had no previous history of skin problems. Past medical history includes mild asthma, hayfever and hypertension. Her medication includes becotide and salbutamol inhalers, simvastatin, atenolol and ramipril; the latter was commenced within the last 2 months to help control her hypertension. Examination There are multiple annular hyperpigmented macular lesions on the skin over her face, neck and upper chest (Fig.
The low complement levels should trigger testing of C-1 esterase inhibitor (C1-INH) levels (suggesting acquired C1-esterase inhibitor deficiency). This patient needs thorough haematological assessment looking for an underlying lymphoproliferative disorder. Further investigations include tests for serum lactate dehydrogenase and ␤2-microglobulin, immunoglobulins and protein electrophoresis, CT of the chest, abdomen and pelvis as well as lymph node and bone marrow biopsy. When confronted with angioedema in the absence of urticaria it is important to consider diseases mediated by bradykinin such as C1-INH deficiency (which can be genetic or acquired) or induced by angiotensin converting enzyme (ACE) inhibitors.