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I have talent. Can you please come in five. That you one of the sudden close I alot Yeah. I am one of the present, isn't it? Did you have tried Sharjah's great Just making me so sorry guys will be starting to Yes, let me just charged her and we're screening just a second. Great. Yeah. I'm trying to go like to start start my video bases. I'm unable to start me pretty prison reason. That's okay. If you can do video, don't worry about it. Well, then we can start with our lives. That's yeah, just as Thea um, you can't start your video because the host has stopped it, so really There. Okay. Oh! Oh, yeah, yeah. Yeah, great. So thank you very much for coming today, guys. Um, another A set session and two, You've got a special session because we're going to be teaming with Cardiff Dermatology Society. So I think of you might see me before on, but how come it's going to be joining us today as well? To teach half the session. I'm gonna teach heart this session, So how can you just go to the next slide, please? Sure. Yeah, So just you know, everyone knows about there's been a change, Teo some of the session. So if you just check the Facebook group for rheumatology on for a anti, there should be some updated dates for their on. Sorry about the session on pediatrics, which has also been updated. So just look at the face book for that or the INSTAGRAM. Great. So we're going to start with the dermatology today. So if, uh, how come if you just take over and go for it? So happens gonna teach, um, acute dermatology on inflammatory conditions, and then I'm going to do some cutaneous skin infections and belligerency. If you have any questions, please put them in the queue in a and they'll be answered. Also, feel free to use the chatter we tell you to on going to be interactive. Get involved to the SBA is right. So, um, if you wanna give Yeah, sure. Absolutely. Yes. And my name is I come to bury, and I'm a final year medical student. Um, the 50 rap off, uh, derm sock. Um, and I have, um, a special interest in dermatology. Some very interested in damages. Why? I'm doing this teaching today. Um, so today I'm gonna be covering acute dermatology and inflammatory skin conditions. I'm gonna be covering of the most commonly asked conditions and progress tests and and exams. Obviously, there are many other inflammatory skin conditions and other acute dermatology conditions that I will be covering today when we're covering the most important ones. Okay, so we shall begin with, um, acute dermatology. It's interesting with an SBA. Um, Senna is a 45 year old female need newly diagnosed with central hypertension. Her GPS prescribed her ramipril to control her BP. Within the first week of fuse, she begins to experience some swelling around her lips. On examination, her lips look swollen, which has no other skin abnormalities or or the, uh what is the most likely diagnosis? Particular occlusion like this glandular s drug induced. And you Dema Michael Michael Soon Rosenthal syndrome or a drug induced photosensitivity. Can we launch the whole please? I can case the results. Yes. So I'm Joya. Stop sharing or Oh, it's ended. Okay, great. Um, so that is correct. Eso the correct answer is See, um, this is a classic presentation off. Um, aces and Hib it. Er induced on Judy MMA, which is a rare but potentially serious adverse drug reaction of a sin hip bitters. It usually occurs within the first few weeks of starting treatment and is characterized by facial lip or tongue swelling in the absence off an urticarial rash So you'd have this some classic lip swelling on. Do you have no visible rash is, And that would definitely lead you to think that it's a drug induced, um, and you demon. So speaking of Angioedema, let's kick today's session off with, uh, urge a curious, the first acute condition. So this is also known as harps. It's a hypersensitivity reaction caused by a mass cell degranulation and release of histamine and face so active make mediators. Um, the presentation usually is comprised off wheels, so those were superficial swellings of skin, and they're usually very well circumscribed plaques. Um uh, and they're usually quite itchy and earth immitis. Um, with a smooth surface lasting about less than 24 hours, Um, you can also get, um, angioedema, which is a deep dermal swelling with no readiness. And that is basically what we what we have just seen in the previous photo which is usually, um, swelling up a deep dermal tissues affecting the, uh um cutaneous um, sorry to you being mucosal surfaces as well. Um, and finally, you can have the ah basketball list type picture, which is known as urticarial back with a basket litis, which usually stinks, Um, and it persists for longer than 24 hours. And this is what's us it off from wheels. Um, and they usually can, ah, present us purpose or just bruising's. Um, So, um, I I mentioned, and it angioedema with no wheels or urticarial rash warrants. The exclusion of a sin him bitter induced and edema, or C one esterase inhibitor deficiency, which can be acquired or hereditary. Um, and urticarial vasculitis would essentially warrant further investigation of that may be associated with SLE, systemic sclerosis, IBD or even lymphoma. Um, the cause is off your dick area. Um, basically depend on whether it's an acute or chronic presentation. So if it's an acute presentation, meaning, but it's lasting less than six weeks, it's usually induced by allergens. Food, drugs or even infections on day usually are caused by non allergic or allergic mechanisms. Usually it's an I G E response um, on the other side. If it's a chronic presentation many guys lasts, it lost more than six weeks. Then it would ah usually be caused by some form of an auto immune or combined reaction. And usually those air known allergic Um um, mechanisms caused by i g antibodies in terms of the investigation, Um, you'd obviously want to, um, take blood tests so you'd want to do a full blood count and s are, um, to check for, um inflammation. And you want to do a thyroid function test and see four levels as well. Um, uh, which your complement protein. Um, and you'd also want to Dom have a tight sister ology or HIV as well. Um, HIV investigations ask for the management. The most important thing is that you do want to rule out anaphylaxis, and that would be a very kind of obvious, Um, and once you feel about out, usually depending on the severity of the presentation, um and, um, the basically the duration off the Arctic area. So if it's a cute, usually it tends to be self limiting. And there ah, the most important thing would be to avoid the offending agent So that is a particular allergen or a particular drug. You probably want to avoid that. You can also use antihistamines, each one antagonists if necessary. Um, and in more severe and more severe conditions do you may need systemic steroids. So that's rescue therapy due to some stomach gets steroids. So, um, that should basically cover arctic area. Now we'll go on to, um, a red throat derma refer Derm A is basically characterized by Eric generalized erythema covering more than 90% of body surface. So generally patient presents with generalize pretty recover most of their body. Then you basically, um ah, you would be suspicious. Uh, the fact that it's probably, er three germ A, um and then usually earth or German A So, um, a sign. And, um, it's not a diagnosis. Um, so usually it depends on the underlying cause. Um, usually, patients would also present with systemic symptoms due to skin function impairment. Because you have skin failure essentially, and this can be tachycardia hypo or hyper thermy A. You have a risk of Subsys on and you can have swelling and edema. And obviously, due to, um, skin and function impairment, you'll have fluid and protein loss. So the cause is off earth. A derma are multifactorial. Um uh, It could be so. The really multiple causes, um, could be drunk reactions. Um, And as you'll see what today's presentation drugs are some of the most common culprit for the acute continental dermatologic away conditions that can be a drug reactions. It can be extremely covering most of the body surface. It can be a psoriasis, uh, psoriasis flare up. It can be due to a cutaneous T cell. Lymphoma, which is noticed, is ari syndrome. Um, and it can be idiopathic, which usually comprises about 3% of cases. Um, in terms of of the management, you definitely want to treat the underlying cause because again, your throat or my most the time is usually a sign. So if it's a neck MRI, psoriasis flare up and you want to treat that, then you'd also want to withdraw the offending drug. Um, you would definitely consider omitting patients and their systemically under Well, um, you'd get it or giving them IV fluids and electrolyte replacement and manage their body temperature. Um, other types of mountain. It's usually supportive, so you'd want to um uh, you want a lather them with emollia. It's usually 50 50 type of millions. Um, with or without topical steroids, depending on the severity of the condition. And then you can also give antibiotics if there are any, um, signs of infection. Um, but generally speaking, it's more of, ah kind of treating Don July and causing the support of management. And obviously you don't want to confuse this with toxic epidermal necrolysis, which is the condition that'll cover now. So Steven Johnson syndrome or toxic epidermal necrolysis um, is a rare but, um, potentially life threatening skin reaction, and they're essentially usually variance of the same condition. So you can imagine a spectrum off the same condition, and depending on the severity, it's either termed as yes or toxic epidermal necrolysis. Usually patients with Steven Johnson syndrome present with sheet like loss of skin and mucosa, which usually has occurred within 2 to 3 days of presentation. And prior to that, they would have a kind of a prodrome a while, um, type picture with flu like symptoms. It's usually a sudden onset of of the lesions they mostly affected trunk more than the limbs in the face. Um, and they're usually macule, um, blisters and erythema. So, um, usually with the earlier you get those atypical target. Oh, really? Jin's, um which are different from a kind of the typical target of target toe lesions that you've got another skin, um, conditions. Um, usually, essentially, this is confirmed by, um uh, or usually seen in skin biopsy because you get an extensive full thickness mucocutaneous or epidermal necrosis. Um, and the reason why you get this epidermal detachment is because the blister sometimes merged together and that causes thie epidemics to detach. Usually that you get this wet wallpaper look. Um, and, um, with the presentation, you get nickel ski signed. Positive. Um, so that's basically one of the signs that you can elicit just by basically to see if the skin scrapes off in terms of the causes. Um, again, um, it can be cell mediated. Um ah. So usually it's so sorry. So usually it's a cell mediated side talk to reaction against at the Jermell Selves, doctor, the etiology. But in terms of the causes, drugs are the most common costs. They're usually, uh, they usually would have been started three weeks before the onset of the rash on bacon prize about 80% of cases. It's important to um, know which type of drugs are the kind of most common causes of, um, ones. And the most common drugs are antibiotics, and they're usually be the lack Tums, Um, antibiotics and self on a mine. Um, anti convulsants are anti epileptics are also common causes of drugs, and that usually includes benetto and carbamazepine or lamotrigine. Um, and then you can also have insets. And allopurinol is a very, very common drug. Yes, well, um, so in terms of differential diagnoses, you'd consider staphylococcosis. It's cold. It's syndrome, which is another acute condition. Consider a thermal burn. You can consider cutaneous graft versus host disease. Um, usually, um ah. There's a scoring criteria to basically determine the severity and mortality of patients presenting with as yes or 10, and it's called score 10, and that basically looks at age heart rate, the initial percentage of dermal detachment at presentation. It also looks at blood test abnormalities. Such is your urea and um, glucose, and also looks at the presence of it takes the presence of malignancy into accounts, um, in terms off kind of just to define the two different terms was obviously, although they fall on a spectrum of the same kind of disease pattern. Usually they're they're defined. So as the ass is defined by a body surface, um, area detachment of less than 10% and talks. A cup of dermal necrosis is defined by body surface area detachment of more than 30%. And if you get um, ah surface area trash in between 10 to 30 then that would be in estrus. 10. Overlap. Um, now, in terms of management for this condition, no treatment is needed if it's mild. If it's as they ask, um, and it's presented, Um, it's a mile presentation that usually wouldn't consider certain treatment immediately. Um, you'd obviously want to treat the underlying cause if you've managed to identify that. So if there is a drug, let's say the patient has recently been started allopurinol for a doubt prophylaxis. Um, then you would definitely consider withdrawing. That drug may be replacing it with another one, and you'd want to prescribe anti virals or antibiotics for infection. Um, so if if in infection was identified, it's important to keep in mind, though that sometimes you can not always withdraw the causative drug because of let's say, the patient is on life saving antibiotic. It's called, um, that's causing Stephen Johnson or a text toxic epidermal necrolysis kind of a, um, it really is gonna weigh the pros and cons of food, wrong treatments. Um, again, with, um, with this condition, it's there's also kind of supportive measures that you can take. Um, and that would comprise, um uh, emollients, um, and topical steroid. So, essentially, this is kind of true skin failure. Really? Because the skin is actually falling off. Um ah. Usually you'd get top topical steroids for itching, and you can apply and non it here and dressings a swell. You also want to leave the detached epidemics on just a kind of act as a biological dressing. And you'd want to admit patients in severe cases for intravenous hydration and skin protection. Um, because it's so so based on to their score. 10, um, kind of score. Um, they can eventually, um, kind of conventionally toe. Why drink of wider a breo of complications. So in 30% of cases, especially like severe cases, you can take me to mortality. Unfortunately, in death, if there is i involvement of coming to blindness, Um, and there you can also lead to dehydration. Hyperhydrosis me an organ failure. Um, so So organ failure that is outside a skin failure, obviously. So if you'd want to consider I an urgent off a multi referral if there is I involvement to prevent blind us. Um, now, um, upon too are, um, third condition today, and that's accident her pedicle. And this is a very, very, um, important dermatologic Elimiron ginseng. So, essentially, it's a disseminated Beira Lafayette in caused by herpes simplex virus one or two on the background of an eczema diagnosis. So usually a presentation is an abrupt relation of eczema because most of the patients who usually have eczema and you get those clusters of monomorphic blister So the blisters all look the same. Um, and they're usually fluid filled lesions, and they appear just like early cold sores. They're usually punched out. Skin lesions that are very painful and extremely itchy on those lesions can be circular. They can be depressed or even ulcerated. Um, you can You can also get severe systemic illness. Um, with with Exelon herpeticum of that which, um ah, be what I would consist of a fever, lethargy, vomiting and orexin. Uh, diarrhea. And, um, ovations usually happen, but not the, um, in terms of the investigations, you would definitely want to get blood tests. So a culture but culture on full blood count a urea and electrolytes, Um, and CRP Oh, you also definitely want to get viral swaps, and those are usually taken from the floor of a burst musical or the fluids. So you want to swap that out on. You can also send bacterial swabs as well to investigate for emphasis. I go, which can present similarly, or a secondary bacterial infection. A swell, Um Now, as for the management's, you'd want to start, um, promptly with acyclovir and those either world or intravenous, uh, intravenous I stock liver is usually started in patients who are two l or are unable to tolerate world acyclovir. Um, and it's usually 400 to 500 mg for five days, So 4500 mg. Um, I think it's usually five times a day for five days. Um, you don't consider, um, antibiotics. If there is a secondary bacterial infection that would be usually either catheter I Aczone or clarithromycin of their pen. Allergic. Um, if a child with, um with a top of excema has any lesion on the skin suspected to be herpes simplex virus, you'd want to start them immediately on Drainage two presents. Um, the occurrence of accept her pedicle. Um, so that's just kind of one thing to keep in mind. Um, and you also want to refer those patients to ophthalmology because of the patient of the lesions are close to their eyes. Um, you you'd want to refer them toe exclude excema. Um, her basically toe areas like exclude, uh, examine her better come, uh, just basically affecting their eyes, which can lead to bed and loss. So, um so, yes, it is another really serious condition. Now, um, we've kind of just covered the three most commonly asked acute dermatologic conditions. And now, on the lawn, Two inflammatory skin diseases on her first condition today is, um, a topic excema. Um a topical, um, actually is usually caused by barrier dysfunction, which has a genetic association in prison. Patients with eczema tend to present with itchy, chronic and inflammatory skin lesions with a remitting relapse and course. Um uh, if it's an acute presentation than the lesions tend to look for them anus. Um, and they tend to look crusted a swell so you could see a bit of crust or eggs a day. Um, and you can have a blister. So either small, basic ALS or bully a swell and as you can see, but the picture of the top is a basically depicting accu XMS. It is quite red. Um, if eczema is basically left untreated and it eventually becomes chronic, then it would be very much of the er them a this. But it would be very like if I'd which basically means that this can gets quite thickens and pigmented. Um and it usually becomes scaly, and you can see that I could barely make it out, actually, um, in the second image. Um uh, just under the one of the one with the acute, um excema. So usually you can have this allergic march, which is a combination of fried itis, asthma, um, and um, allergies as well, so you can have hay fever, and then you usually also tend to present with a topical eczema. Um, and most of the time except tends to affect, um, the Flector ulcer offices and the face and in infants. And as you can see in the third photo, um, it's it's very common condition. Infants actually, um, in terms of the, um because is caught. The most common causes are usually inhalent allergies of pollens or house dust mites. Food allergies to just milk or eggs comprise 5% of cases. And then you can have a retention such a soap or detergents, which may also lead to the occurrence of excema. Um, you can also get, um, contact allergens or infections, causing eczema as well. You'd also want to consider cow's milk protein intolerance in young infants with moderate to severe X amount that is refractory to optimal treatment. Um, so that's 11 cause of excellent in young kids. Then, in terms of investigations, you might want to get a bacterial or viral swamp to rule out infection. So as we kind of mentioned, you can get access her petticoat, Um ah. And you might also get a secondary bacterial infection, so you might want to get a swab to rule out and treat um, some potentially serious infections now ask for the management of excellence. It's really just there somebody kind of things that usually are prescribed, but most of them fall under emollia. It's and steroids. Um, so essentially, I think with a lot of, um, uh, skin conditions, you'd want to address and treat suspected causes. So if you identified an infection that has recently triggered a next Ms flare up, then you want to treat that infection first. And then once you've treated the infection, then you'd want to um, uh, t kind of manage excimer. They do need one a consider in moments and steroids on. Do you want to get that patient on a particular skin regime of a million plus or minus? Steroids usually administrated based on severity. So, um, steroid ointments are usually given, um, based on the different types of certain. Um, it's usually given based on the X um, a severity. So if it's mild eczema, um, were you have areas of dry skin with kind of infrequent itching, then you'd consider given hydrocortisone 1 to 2%. So that's topical. Obviously, if it's moderate external, where which is usually characterized by areas of skin with frequent itching, Um and readiness marked redness on sometimes excoriations. So just kind of, um actually signs of, um of itchiness. So excoriations or basically, um, just, um, kind of marks all over the skin from, uh, kind of intense itching. Then you'd want to give them. You move a or benefit are, uh, so the Celexa, Those are usually more potent topical corticosteroid. And if it's if it's severe X, um of that which usually is the characterized by diffuse areas of dry skin with a lot of itching, a lot of bread nous some excoriations. In some cases, you get the leg nitpicky. So I think the thickening of skin and pigmentation of skin and in stores you can get bleeding, cracking and fissures. Then you'd want to give thumb some very, very potent topical corticosteroid. It's like reading a baby. Um, and most of those kind of topical stars really started for 7 to 14 days twice a day. Um, so usually kind of other other measures or taken. So so it almost always want to prescribe a multi institutional with eczema, and you instruct them to use those moments for moisturizing, for washing and for bathing. Um, and they should continue to adhere to that skin Rodgersmen, Um, after their eczema has basically, uh, basically has been kind of, um after it has gone down to prevent a flare ups because if they stop using it, then you can basically, um, get some merit skin irritation. And that would cause the X amount to flare up again. Um, and usually products and pumps air preferable to tops to reduce the risk of infection. And you'd also want to avoid soap and you'd want a washes. Well, so with the millions, um, you'd also want to manage infection. So again, if it's bacterial, you'd want to use something like, um and or alcohol amox clav or can tracks. And if it's of widespread back to your old infection, Um, they've recently started kind of using other types of therapy. So other therapies you'd consider would be a topical counseling urine inhibitors. It's just tacrolimus, um, or ultraviolet ultraviolet light. Um, be phototherapy is usually kind of fused, but for more severe cases, a swell. So that is excellent. No one would want to psoriasis. So psoriasis is this is a chronic inflammatory skin condition. Um, it's it's classified as an immune mediated disease, and it usually causes skin hyper proliferation. Um, the classic presentation of psoriasis is a well demarcated kind of very well circumscribed red, scaly plaque on there usually send the symmetrically distributed, and they're characterized by those silvery white scales. Commonly, a psoriasis affects extensive surfaces, but then you have kind of different types of of psoriasis. Plaque psoriasis is usually the most common, and that's the classic description of those for the well demarcated red, scaly blocks. Flexeril Psoriasis is psoriasis, which occurs and, um, flexure is basically so skin folds. Um, and this usually contradicts the classic appearance because the skin usually tends to be smooth and shiny, and this is depicted in the second image on your rights, and they usually have a white killing surfaces. Well, now got a psoriasis is another type of psoriasis. It's a psoriatic rash. Um, that is kind of red, and it's a basically characterized by those teardrop lesions, which are usually preceded by, um, a strep infection. Um, and this is depicted by the image in the middle, just the, um, basically between the ones on the top in the bottom, and then you can have postular psoriasis, which usually effects, um, the palm's and soles. They're also it's also known as Mama, Planter, psoriasis. And, um, you can also have scalp psoriasis as well, which tends to affect um, the scalp. Now patients was dry. Has can have other signs outside of this affecting kind of other parts of their body outside of the skin. So you can have, um, pitting or on a cholecystectomy basically where the nail bad separates from the actual nail. Um, and, um, it can be associated with arthritis. So that's something to keep in mind. The patient has been, um, basically suffering from, um, joint pain than you would suspect through attic arthritis. So causes off psoriasis. Er again. Multifactorial. Um, there is a genetic association with HLA B 13 in HLA b 17 and CW six. So again, there is some genetic predisposition. Um, there's also an immunological kind of, um, there's a role for the immune system is well, and usually it's due to a number, uh, aberrant T cell activity, and that basically drives the keratinocyte proliferation. Um, now, there are some environmental causes. Well, um, so psoriasis can be worsened by skin trauma or stress. Um, it can be triggered by strep infection, as in the case of gout, take psoriasis. Um, and in some cases, it can be improved by someone exposure. Which is why, um, phototherapy is used for, um, for certain cases. Now, in terms of investigations, psoriasis is a really a clinical diagnosis. You'd want to use the posy score to assess severity and to kind of quantify and and just make out how much. Um, uh, patients are being affected by by psoriasis in their everyday life because it can be quite debilitating. Um, asking condition, um, now into the management. Um, it's comprised off topical therapy. So that includes emollients cold tar preparations. Um, vitamin D analog. That's just calc calcium poetry, a little topical corticosteroids and counseling. Euro. Cancel it, Cow. It's in your in inhibitor. Such a stock. Really, Miss, um, Now, again, you can also use phototherapy, which is, um, which can I to be narrow bound, UVB or broad bound to be be as well as photochemotherapy, which is, um, also known as Serlin. You be a, um no. Other ways to manage dry since include system systematic, basically a systematic on drugs. So methotrexate cyclosporin which is a an aural um So a systematic house in your inhibitor, then you can also give biologics In some cases, um, which are usually tumor necrosis factor inhibitors just infliximab. So in terms of the nice, guidelines usually recommend a stuff wise approach for a chronic block. Psoriasis and usually, um, uh, you'd want to start with regular emollients to help reduce scale loss and reduce kitchen on first line. Nice recommends a strong corticosteroid applied once daily um, stress, but no veil with a vitamin D analog. A swell. And they should be applied separately, one in the morning and one in the evening for up to four weeks. And if that does not cause any improvement than you'd stop them up to a vitamin D analog twice daily, um, and the opponent corticosteroid and vitamin D. And for third line. If they're they haven't really experienced any improvement for, um, but up to 12 weeks, then you you can either offer them a potent cortical steroid applied twice daily or a cold tar preparation of other ones twice daily. Um, secondly, care management is usually comprised of phototherapy, which I just, um, explains. So usually you can refer them for photochemotherapy, which basically helps in a lot of a lot of cases. Um, you can also, um, administer assistant systemic therapy. So oral methotrexate usually first line. It's it's particularly useful in those with associated joint disease. So psoriatic arthritis. Um and, um, you can also give them cyclosporin, systematic retinoids and the biological agents. But those done to be reserved for more severe cases. Um, yeah. Now let me move Colon too. So again, if it's scalp psoriasis, you can you can give them, um uh the topical corticosteroids or jump Ooh, preparations, which usually incorporate um, agency just sells like acid. And what not so it really depends on the type of psoriasis, But mostly it's comprised off those therapies that just discussed. Um, no, we don't want to our final inflammatory skin condition. Um, and it's acne vulgaris, Um, and that's usually very commonly tested. So it's a skin disorder commonly affecting adolescents, and it's characterized by obstruction of the pilosebaceous unit or the follicle with carrot in plugs. And that needs to comedones inflammation and postural formation. Um, so presentation usually comprised off, um comedones toe. So those are non inflammatory lesions caused by dilated sebaceous follicles, and they can be either closed and those would be white heads, uh, or open, um, and those are term to kind of close early blackheads. And the reason why they're called black outs is because usually the the carrot in plugs oxidate on exposure to a restaurant and that turns thumb into kind of the stark black color and hence name black heads. Um, so comedones are more superficial lesions, but then sometimes you can get inflammatory lesions, which include populace and postule. Um, and they usually occur after a follicle rupture, and that kind of causes the release of irritants. And then it dries the the the occurs off populace and postule. Um, in more severe cases, you could get no jewels, insists or suits pseudocyst inducer more deeply Zins. And they're due to, um ah, kind of. It's very kind of strong inflammatory response, Um, and finally patients with acne vulgaris comma present with scarring. So those could be, uh, I speak scars. Hypertrophic scars, um, which are basically like dents in their skin or pigmentation. Usually it's a hyper pigmentation, so that's, um, uh, do to, like do to kind of the inflammation. So it's a post inflammatory hyperpigmentation? No, in terms of the management management, um, basically is comprised of topical therapy, so that could be topical retinoids, benzoyl peroxide or a topical antibiotic. Um, you can also give or allow antibiotics and um, a the combined or old contraceptive pill for a woman. Um, and you can also give them either trip know in as a final resort. So let's go quickly. Go through the the step, the the management that you would give for patients with acne. So it's a usually a step of management scheme similar to psoriasis. Um, and usually you start patients with a single topical therapy, so that would be either, Um, topical retinoid like adapalene are different. Um uh, or you can give them a benzoyl peroxide gel or wash. So one of the's, um now that doesn't work, um, or their acne worsens. Then you'd want to give them a topical combination therapy, so that would include a combination off either a topical antibiotic with a benzoyl peroxide or a topical antibiotic with a topical back. Now it's adapalene, or, uh, sometimes you can get a topical regiment with benzoyl peroxide. They've got doesn't work that you want to step thumb up to or Lantus products. And those usually the most commonly used oral antibiotics are tetracyclines. So those include line the cyclen, um, doxycycline. And usually you'd start patients for about three, a three month course of oral antibiotics. And if that does not, um, cause any resolution of, um, their their acne than you would consider giving them iron either the world of the combined world contraceptive pill. And they're usually specific pills that have anti androgen effects, which can help. Woman um ah and can can really help dump in the, um, the appearance of acne. Um, and in most severe cases, you would, uh, prescribe thumb or realize it with knowing well, it's usually a a specialist. It's usually under specialists supervision, so it's usually only prescribed by dermatologists, and you'd want to ensure that they're not pregnant and their own very effective contraception because it's highly track a cardiogenic. And it can cause, um uh, basically fetal abnormalities. Um, now, in terms of acnes, you also want to keep in mind acne severity one managing patients which can sometimes surpassed that kind of stuff, where his approach of patients present with really severe acne might consider, um, you know, going straight to, um ah, toe or Lantus biotics with some form of topical therapy, other topical retinoid or benzoyl peroxide. You wouldn't give topical oral antibiotics at the same time. And acne severity is usually dictated by the type and number of lesions present. So if they usually they have comedones and inflammatory lesions closer populism pusstrils than that, would they only have those two types of lesions And that would usually, um, uh, b graded us? Um, a mild to moderate acne, Um, and usually two Sep to distinguish the more modern water. It just depends on the number of lesions. So they have 15 toe, 50 popular and pastas, and that would be moderate acne. Um, Now, if they had the presence of pseudocysts or cysts, as you can see in the bottom photo here, um, then that would be suggestive of more severe disease. Um, and you know, you might want to be a little bit more aggressive with your management's. So, um, we'll move on to a, um, a nesky to kind of end to the section. Um So the name is a 14 year old boy who has recently had a streptococcus infection. He's presented to keep the surgery with a widespread psoriatic rash. On examination, there were Oh, sorry. I have gum accidentally spelled. Where? Um, there were them anus. Teardrop lesions covering his back. What is the most likely diagnosis? So sort of different types of psoriasis Isn't plaque psoriasis? Got a psoriasis Flexeril. So psoriasis, scalp, psoriasis were postular psoriasis. Okay, you guys have, um, chosen the right answer, so yeah, it is. Um, it is, actually. Are you guys have said, Um, sorry. I'm just really wanting the polls. Oh, I say, Okay. I was looking at the I was looking at the previous fall. Yeah, yeah, yeah. You gotta stand too still know the right answer. So, yeah. So it is good to exercise this again. So you'd want to think about the fact that first of all is a 14 year old, um, boy, um, and got a stress is, um, to be commenter in, uh, Children. Um, And also, given the teardrop appearance and the history of a stroke infection, which usually cause us that the psoriasis thumb um, you're right is got interesting. Indeed. So now I'll move on to your woman. Want a bacterial infections with safe. Um, So I stopped screening. So stop sharing screen, and then you can, um, sure, yours. Yeah, that sounds good. Thank you. Okay. All right. Well, thank you so much for listening to the first two sections. We'll move on to, um, look, a bacterial infections. Okay, man. All right. Can you see my screen? How come? Yes, I did, Kanye. Okay, great. So it's people section Good. Wonderful. So if everyone can see you see, my screen happens all right? Yes, it's perfect. So you're describing derm terms, right? So, yeah. So what I'm gonna do is thank you for doing through those two sections. So we're going to talk about infections and we're also going to talk about and malignancies. Well, just to start up with that, would it would be helpful now that you've gone through a section with that came about different conditions. Actually, knowing how to describe the terms on will cover this a bit better in some of the osteo stations which were planning and again a couple of months. But these are some other think, the most important terms that you should know when you're doing any dermatology, SBA or even for for ask you so on. These are some of the times I would I would look at the actual that means it's distal. If it's central. So is it flexor extensors. So is it on the interior where you flex your arm? Where is on the outside, where you extend your own? Is it localized of generalized? Doesn't spread anywhere else. So is it damp? Atonal? So we have different dermatomes on our skin, and some some infections actually follow the patterns of those. Dermatomes isn't follicular. So is it in the follicle of a hassle, and then some other important terms To look at it when you're describing a lesion is what is the shape? Is that circular linear? Is it annular, which means is that ring shape on is irregular, so you look at the border and you can you can tell for about well demarcated means that the border is you know you can. You can define it by drawing easily. If it's still defined. Does it sort of blend into the other parts of the skin and is it raised or flat and Then there's all these other secondary, um, secondary descriptive words as well. So things like excoriation, which I'm already described on. Then just here's ah, really nice table of how you describe set another lesion. So if they're smaller than normal person to meet us versus larger than your 0.5 centimeters, if they're flat or raised on, then if they've got something in them. So if it's for example smaller than normal and five centimeters, but it's raised, and then when it's lanced on bus comes out, then you know that it's postural. All right, so that's just for you to look over in your own time. So just a quick warning. There is some some graphic images if you're a little bit squeamish just to prepare you. Great. So for that, our first bacterial infection section. So I'm gonna start with an SBA so sorry. Hip is an eight year old male with golden honey colored lesions on the corner of his mouth, but nowhere else has shown in the image below. As you can see, he's got those lesions around the corner of his mouth, and he's a Pyrex girl. He hasn't had severe pain or any changes in bowel movement. So what is the best management for this patient? So I'm gonna put the polyp. It's really just fall. No, let's give you some time to answer many of you as possible. Given answer. All right. Great. Well, stop it there. So yeah. So some of you went for see, some of you went for B. So the answer is, the answer is be so if you can see that acidic acid is the answer and I'll explain to you why so the FEC gases. So the reason why I suggested a cast it is for a couple of reasons. So, firstly, we want to look at how the patient's feeling so well, if you could just put in the chart. What does everyone think this condition is? You can just type in the chart. Yeah. Wonderful. Impetigo. Well done. So yeah. So this is impetigo now. Sorry he does. He's a pyrexia. Which means that he's not particularly unwell. Andi, he doesn't have any severe pain, just doesn't have any bowel changes on this brush that he has hasn't spread that extensively. So that's the reason we have visited casted. Um, but what is what is impetigo so in. But I go is the acute, superficial bacterial skin infection that's usually caused by staph aureus, and you get these sort of gold honey crusted people them sometimes when the colored lesions, which are usually postular aware that erosions and that typically found around the mouth or Flexeril parts of the limb. It's really contagious, and it spreads by direct contact with the discharge from the infected person. Eso. The fact is, that predispose you to This would be a topical. It's a mercy for patient if a child comes in and they got this strange rash then and they've got a history backs, um, it's something to consider. Also scabies. Skin trauma from things like chickenpox when it scratching in six pies, dermatitis or laceration. Also, young men who was shaving. Or maybe the hygiene stand is not that great. Then my also end up getting a tiger on how you diagnose it. Well, it's a clinical diagnosis, but you can confirm it with bacterial spots or send them CNS on it. It's quite it's widespread that you'll get raised neutrophils. So how do we manage it? Well, if it's uncomplicated, like in the case in this case that we looked up. You'd give a 1% hydrogen peroxide cream or a topical antibiotic cream like you said it acid, which is sort of a really common answer. That's in this case. If it's extensive and the patient's information was really unwell, they was spiking a temperature on Do you know the altered bowel movement, like Children will often have altered bowel movement they might want to eat. Then, in that case, you would get a flu clocks still in or erythromycin if they were allergic to penicillin. Now, other things about this condition are important to look at, so we need to see if the student needs to be excluded from school. To stop the spread, avoid close contact, keep the area clean. A pliant a septic have covered the infected areas and make sure you cut their nails and keep your hands clean as well. So on your next test, be a So Sabra is a 36 year old female who is G two p one in the third trimester, you know, do you know lateral erythematous inflammation of the skin around the thigh? She's systemically unwell and shivering. She has a past medical history, off gestation diabetes, her white cell count and crp a raised blood. Cultures come back positive, and she has no allergies. You initiate a B C D approach because you're worried about her. So what is the most appropriate first step? So I'm gonna just put the polyp with the bullet, okay? Just get a few more of your cancer. Just have a guy i z, even if it's difficult. Just have ago and I had the question and you might surprise yourself. Just wait a little bit more. Okay? Cool on the pole there. So quite a mixture between the answer. So 80 and so people are choosing across the board. Um all right, so I'll explain to you what the answer is in a second, just on the pole, and you can see whoever else is done. So the answer here is, actually, um, see, comb OxiClean of. So, for those of you chose, be in a you're not incorrect. So you know, you Those are treatments for for this condition on Deacon. Anyone write in the chart where they think this is, Please spots before I give you the answer. So what condition is this? Yeah, well done. So, cellulitis. So, yeah, this is cellulitis. How do we know it's cellulitis? Park is unilateral. The patient's systemically unwell on. Also that the shape of that the the rash location on you know, with the picture that I got there is well is indicative of it. She also has a hospital history of gestational diabetes. That might be a risk factor for it. So usually you would give flu clocks. But if they're allergic to penicillin or pregnant, you then give birth from my sensor wise and the answer it for myself. In this case, which a lot of you choose. It's because she's acutely unwell, and in that case, you need to give IV antibiotics. And erythromycin is usually given orally. So in this case, you need to give her amoxiclav. And this is according to nice guidelines, so I'll just go on to so the next slides. So yeah, so so you like. This is inflammation of the skin and the lower Dermus and subcutaneous tissues, and it's typically due to infection by strep Argenziano stuff aureus. So it's often unilateral on do if it's bilateral, you need to consider other things like cardiac failure. It's most common on the shin, and also that sometimes we'll see that picture on the on often doctors or the nurse or whoever seen the rash. First we'll write. We'll draw a line around the rash to see if it spreads on. Um, from what I remember is that if the rash is moving upwards and that's a more signs of patients accumulate well and that that is getting worse. So you should always a draw, draw the line on there and any rash that's large and flush. Sometimes it's associated with systemic upset of skin conditions on a can occur by itself or as a complication. There's another condition called Aricept list, which is when only the epidemics is affected, and that extends to the superficial. Cutaneous lymphatics on. The diagnosis is clinical, so you use white cell count CRP on. Then there'd be a wound or erosions or crust so you could do a swab culture there. So how do we manage it? So it's in this case, Uh, it was It was more urgent to do an A B C D approach, but if it's uncomplicated and there's no signs of this systemic illness, Then, as I said, you give flu clocks still in and clarithromycin for myself in the patient was pregnant or doctor cyclen and penicillin allergy given a cheesier adequate fluid intake on, um, also, you need to take a history of any other skin conditions that they have on. If it's complicated in this case and you can give, um, you can give her, um, oxygen level or several steam. Some people might think. Is there any coat and any interaction between being pregnant and using Caremark Sick Lab? From what I looked on, nice guidelines. It's perfectly okay to prescribe him so foliculitis on X conditions. It's inflammation off the hair follicles, and this could be bacterial. It could be yeast. It could be fungal or it could be viral, and that effects quite a lot of different parts of your body. So it could be the chest, the back, the buttocks, arms and legs. On the presentation, there's tender red spots with the surface postule so they might be they might have a common don't, which are the little bumps on the top that are sort of when you have a zit that's that's full of past and that can be due to a Z, I said. A number of causes. It can also be from a shaving irritation. Contact dermatitis or immunosuppression. There's also inflammatory skin conditions, Michael it like in Venice and discord Lupus, which can really which can occur in there on if you you only treat it, there's an infection present. So, um, if it's bacterial, you do is not a septic a fungal or you might use acyclovir. You need to treat the acne and avoid triggers as well. So like some men might get. Get it from shaving. Um, Andi. Also, you think about use of terrible, topical corticosteroids, but it's less common, so on to infestations. So this is where the pictures get a bit little bit gross. So, um, next SBA is I owe is a nine year old male patient who presents to the GP with his mom with itching, um, which he marks between his fingers on silver lines. There is a widespread excoriation around the area on that currently do not have a fixed permanent address. So what is the first line management for this condition? But the polyp, it's if you ask different, give you a bit more time. Oh, wonderful. And then, if people want to run up in the chat, do you know what this is? Okay, something is a shingle. Somebody said scabies. All right, so and the pole. So most of you went for C says a bit me. And because I just I'm expecting to know the know The percentage is a swell. Yeah, but anyway, it's fine on said. Yeah, well done. So the answer is is C is, in fact, see, So you get the methadone 5% and you have to make sure that you give it to all family members as well, even if they're unaffected. So this condition yes, as you guys were in the chart is actually scabies on. We'll discuss that wide. Now I'm through this, but in so they currently do not have a fixed permanent address. And the reason that's important is because of the risk factors of scabies. So Well, come on that now. So it's caused by the might call the sarcoptic scabies. I I and it's spread through for a long skin contact typically affect Children and young adults, and they'll have widespread itching will have these little linear borrows. And just around here around the area, often in the flexural areas or between the fingers, um on it'll be. It could be a generalized rash on the or red populace on the trunk and limbs so that it occurs about 4 to 6 weeks after infestation. They'll have disturbed sleep on D. Diagnosis is by two matters copy, so you might see a beautiful. You might see one of these horrible things on the demand a scope, but also you might see that what they call silver lines. That's another key SP that's often used. Yeah, well on the treatment is the first time is management method and 5% which is escapist side cream. On the second line is, um, a lot on my life in no 50.5 minutes came for 24 hours afterwards. So, as I said, a progress test tip is that sometimes they'll throw in that the patient's been homeless or they're living in in poverty, overcrowding conditions or their institutionalized. So they might, you know, be in the hospital or in a prison refugee camp. Or they might have an immune deficiency so you guys can read this in your in time for further management, so on to the next condition. Another quite gross one, I think. But it's really common, and a lot of people get out when their Children. Some people have it as adults, so it affects a lot of people on it. So this is particular system. That's a life so that can occur on the head of the body pubic hair. And it's really problem among school Children, and the transmission is by contact between their head or body parts. So even if you share a hat and there's different stages of the life of the last life, so the mature life are 33 millimeters in length and their exact calm. It's and there's about one millimeter in length and you can see the difference. When you look, you usually see the actual eggs on the hair. Um, on the lice might be further down the shaft of the hair follicle, so you'll get intense itching of the area. And that's the allergic reaction to the lice On other different diagnoses are seborrheic dermatitis for psoriasis. So for the management, you might given another in Texas. I'd like the metho a normal Afeyan on it could be in the form of a shampoo. And for knits you do you give you two went with vinegar to loosen the attachment of the hair, Um, and remove the nets for the comb. So yeah, it's a very common condition on a fun fact. And adult last can clot can crawl 23 centimeters in a minute. So if you have a little concerned you know about so on to viral infections. So another SBA So a 14 year old girl much Mark comes for her HPV vaccination. She wants to be a doctor in the future. And so she's worried herself looking on Web MD to know that HPV can cause certain cancers. So what combination off HPV strains are linked to malignancy. I'm gonna put the, uh, polyp that with me. Great. So if you got a polyp So again, a really common question that comes up a lot. Um okay, I'll give you some time to have a go. That one. And then can anyone tell me in the chart what HPV is? Ah, recorded what HPV stands for. Yeah, wonderful human level wise. Just give you a couple more seconds to answer the question. It's not in the hole there. So most of you went for B, which is okay. We'll discuss that and then the second most common choice. Waas d All right, fine. So through the answer here is actually a little bit of a mean question. But the reason I put it in this because it's actually the answers, actually, D so 16, 18 and 33 I mean a lot of your learning. You might have just 16 and 18, but if you just look, a lot of other 33 is also another course. So what is HPV? So HPV is a virus, and it causes more awards. And there's different strains, which are linked to different conditions. So each baby six and 11 are common causes of and your genital warts and HPV 16, 18 and 33 have been linked to cancers cervical, anal, Volvo mouth, throat. Depending on where they've infected on D, the different types of you about the common wart plantar warts, which are these ones on the soles. The group, or verrucous, is there also known on file a form ones which one a long story with the bulb, but the end and then mucosal ones, which are in the buccal areas or inside the cheese. So buckle in tight the cheeks on the lips on. Do you get this phenomenal local carbonless phenomenon where new skin lesions second form okay in patients with warts, and they're also seen? It arises and like complainants. But till I go and, um, other conditions. So what are the risk factors? School age Children? It's common extima, you know, suppression swimmer's but also sexual contact. So vaginal anal oral sex in court can court be a A major transferrable, a major transfer vector but also close skin contact. So not necessarily having sex can can cause the transmission on it can be diagnosed clinically with the mattress copy or a skin biopsy. So how do we manage it? Well, if it's not troublesome, it's left alone and the patient's sit. It will regress, but it's gonna be quite an emotionally damaging Quintus condition for a patient, especially if it's in the genital area or it's on your face. So so they'll use topical, so that's sort of salads like acid. Sometimes they might use cryotherapy, or I've seen them use of the nitrate in some in some situations on the final sort of way to get rid of it is by doing curettage in quarterly for large resistant warts. And that's a type of electricity surgery where the skin lesion is scraped off and then you apply heat to the skin surface. So until I'm just the further management of Andrew dental water is slightly different, so this is caused by six and 11, and you can use topical podophyllinum for multiple non keratinized wards, cryotherapy or image commode. Cream on then, for genital warts is often they're often resistant to treatment, but they might clear in 1 to 2 years of treatment. So to continuous treatment. Just another thing to just be careful of. And in patients where Children you have water gentle area, it's really important to just suspect that there might be some abuse on follow the appropriate pathway on to the next SBA. So, um, I'll just put the polyp Great City Get onto this. So Albert is a three year old who has just started nursery. His mom brings him in because she's very worried about what she describes a bumpy rash on his trunk, and you see pearly white, popular with Central Umbilic a shin. And what is the answer to smile, so as many as possible. So we started little bit later, guys, so we'll just be running in the way of the time, but it would be worth staying, and we'll drop the feedback from two with the end. You can have access to the slides. Just wait for a few more of you to answer. Most of you have got this one right there, I think. Okay. Can. So Okay, great. Wonderful cell. And the pole That's the most of you went for a couldn't says you can see Great. So, yeah, so the answer is a is molluscum contagiosum, so just call it up. So this is a skin infection course. The molluscum contagiosum virus on the transmission occurs by close personal contact. Sharing contaminate surfaces like towels is problem. Children is 1 to 4. Um, and you'll see this pinkish early white popular with the central umbilic a shin. And, um, I've got a five millimeters in diameter. Just be careful of another condition which we're going to come on to, which might confuse this with, but these will often come in clusters. So that's how you can identify them on but supplement. It's self limiting conditions that resolves within 18 months. Hopefully, so it's mostly, um, sort of management of the symptoms. So you know, using emollients and hydrocortisone to alleviate it on. Also, just making sure that the patient keeps clean on exclusion from school actually not necessary for this condition. So the next ones have heard the simplex. So this is a recurrent genital or peri or Olympic shin on. You can get type one, which is all in facial infections, which resulted in cold sores, and they often occur in Children and then talk to you, which is a rectal or gentle infection, which mainly occurs after puberty or patients become sexually active. Um, on this is by a direct or indirect contact. The signs are grouped painful vesicles on erythematous base so you can see it here also see it here on because it's a chemical diagnosis spoke the vial swap could be sent for culture. Um, so yeah, now in again, in patients who are Children, you need to be aware off the possibility of sexual abuse on, then just going on to have be simplex. So we did a little bit about this in the ophthalmology session, lost a couple of like a week ago, so you might see these epithelial carrot itis with HS K. Or, um, it's a dendritic lesion on. You might also see complications like Eye Exam, a petticoat, which had talked about earlier. So on to the next SBA. So saying is a 55 year old man who comes to the GP clinic with a two day history of an uncomfortable sensation on his shoulder. He says it's really painful, especially when it's closer up against it, but he hasn't been able to see what's wrong. So what's the management of this condition? And I'm gonna put the pool again. Great. So if you guys could pick the answer, just be president of you. To answer is possible. Just probably just have a go, even if it's If you don't know the answer, it's the world having Okay, it looks like most of you know this one. Just onto the questions. Electric is being recorded, and you'll get access to the recording after you filled in the feedback form. So I'm gonna end the pole there so well done. You know, most of you got that one. So the answers we were away Cyclogyl. So we'll go through. One is Can you put in the chart where you think this condition is? Please see how many you got? Wonderful. Yeah. Shingles. Great. Perfect. Okay, so the answer is yes. Orally cycle been on. We'll go on to what this is. So this is a reactivation off the varicella zoster virus on that is the chicken pox virus s O. What happens is the visa B virus becomes dormant in the dorsal root ganglia. After a chickenpox infection is resolved on, it can recur, you know, later in life. So the signs off this are painful blistering vesicular rash matter dermatome of distribution. So it follows that pattern. You can see it here is already well on it. Sometimes super. If they're super imposed yellow crusting, then you know it's caused by and stuff or is super infection now in our SBA saying waas over the age of 50. And that's why you gave him a cycle of year if it was mild on, but it wasn't white. Spread officials under 50 and there's no eye involvement and know Hutchinson, Hutchinson, sign herpes zoster ophthalmicus. Then you might not necessarily to give any any treatment, but there is a virtual a zoster vaccine, which is given to patients. But otherwise I think it's a major of 70. Not mistaken. Onder are complications like capsulitis meningitis and posthepatic neuralgia. So you want to fungal infections, which is our last section before a short section on malignancy. And then we're nearly done so candid Isis. So what is compliance is is a yeast infection, which is mostly caused by Candida albicantia on it manifests on many body parts. So it could be This is a really great slide, with all the different presentations that you might see between the thing is and your angular cholitis, which is quite common in people who have deficiencies. Sort of vitamin B, vitamin D or if you have liver problems or GI problems. So G. I S O candidate Africans itself is commenced you alone the mouth and in the GI tract, but commonly, in fact, skin, primarily affecting the mouth of the month vagina. Plans of the Penis skin folds were told whether nail areas basically anywhere that gets a little bit moist, which is is not realize to think about, but that's basically where it commonly occurs on, but they might or might not have satellite lesions around. So we'll do is we'll go on to the next section on. This is how we manage it. So you do an examination. Do a swab to confirm diagnosis. Firstly, minimize respective. To keep the skin dry, use anti fungals on um also give Give him get you can use anti fungus on the skin. So, in matters all for the mouth off you give a nice statin and then for the vagina, you might give him it up madonsela cream or it could be a pessary. So Pessary is, um, a medication that's given a rather than topical is given, like as sort of a pill. Um, well, as a unit, so on to the different types of off of another conditions that this is tinea and this is caused by the ringworm. So you can see a picture of it here on that's indirect man to man transmission or women's women or whoever on that can be one. It can be typically round, scaly, itchy lesion on. What you do is you basically take the name tinea which is three condition, and then add the body part affected in Latin. So that's so. If you know Latin, then you call it would have had start on they usually in the description they might be well and elated. So we talked about earlier about the ring shape that they presented it. So you get different types, so he had got tinea capitis. So this is on the scar on this on the skull on this could spell cup area on deep EKG is your Children 3 to 7. You give a cough. Fungal, um, such as taboo mean on. Then you can use the ketoconazole shampoo and then you've got 10 year cooperates. So that's the body. So corporate on, if it's in the groin is called careerists. And if it's on the foot, that's Copegus. So how do we manage this again? Using the same, uh, topical anti fungal cream such as terrible fino. A man is all for these conditions where it's widespread. You might want to give a north anti fungal, but I will depend on patient to patient. And if you're getting any improvement with the topicals, so this is a little bit difficult one a difficult one to pronounce, not one not to forget those. So I'm going, and that's the hope of pronounce it correctly on that's infection of the nail. So that's increased risk with age on. Do usually is the great or the little toenail that's affected most commonly on again. So this time you would use a topical, anti fungal Asian if it's mild. So, um, are all thin. Or you can use an oral antifungal so terrible feeling on for this one particular, they would usually do nail clippings or a scraping for my cross cross Compean culture. But to be honest, it's it's often a diagnosis that involves just a clinical diagnosis every time. So on your next SBA. So Kinney's has been working towards a bodybuilding competition on when she was preparing for a competition, she saw something different about in the pictures of herself. She notes a blanching off his skin or hyper pigmentation from the neighborhood neck down her back with lots of patches, shades of skin color. She noticed that, um, she noticed that it was worse in pictures off of her on the beach when she was in Morocco. So what condition might she have so you could pull up on a Z? Many of you is possible for it. It's just a few more seconds to let people just have a read. So the longer question, so I'll bring the slides. The uh huh. So great. Okay, so I'm going to end the pole there. So most of you. So most of your went for option A, um on then second most popular answer, but nearly the same amount. People chose Option D. Okay, so I'll tell you what the answer is. So the answer is the answers, actually, D's. It's a bit of a mean question, but we'll we'll see why it is. So the artist. Did you try this particular on the key things in the question which tell us that it's if this condition is that she's It's insidious, so little I go could be insidious, a swell so that that's understandable. But the thing is, she's noticed Hyperpigmentation that's from the name of her neck down her back on it's lots of patchy shades of skin color. So when this the skin has lots of different shades, we think about the secular Well, basically means various shades of color. Basically, um, Andi. Also, she's noticed that it's worse when she's at the beach, so somewhere warm on this condition can be exacerbated by warm climates. So until you explain to you why this condition occurs, so this is called by the Ms Alysia and see yeast infection. It's quite common one on that affect areas of the back of the chest and basically areas that get sweaty. So inpatient people that that work out a lot or have very physical jobs on this might be a condition that they that they have, um, Andi the weapon tries. Is is, is the term used for skin condition characterized by a scaly appearance? Um so the multiple colors off twice, as I said, the reason for why it's called particular. And it mostly effects women slightly more than men. But older, older, but Children and older models are, you know. Commonly they get it as well. So how do we treat it? We use topical anti fungals if it's mild, like imidazoline or Ketoconazole shampoo, and of it's extensive once again. Like many of these conditions that we've discussed, you then move on to all anti fungals. So the main thing about that one was to differentiate. Um, the difference between this little I go. So in vitiligo, some patients might have been have blanching of skin, but it would and and hyperpigmentation. But it might be a more clearly demarcated Erica. Sometimes I'm also a little eye goes on auto immune conditions that might be linked to other conditions. Um, on. But nothing to notify me till I go is that it might come on randomly and suddenly so that his she might be similar. But in this case, that history of them being in a warm climate on also the occupation that leans more towards the triceps physical so on to the skin cancers. So on SBA. So Salima is a 70 year old patients. So it's all our section. Guys were nearly there. Salim as a 70 year old patient who have recently moved his recently moved to call it from Bangladesh. She comes to the GP after having noticed a suspicious lesion on the forearm when taking a derm history from her, and she tells you that she's got a very, very rarely bands in the sun, but she turns very easily. So what skin type does she have on according Teo misspelled. So what skin time does she have according to the Fitzpatrick scale? So I'm gonna put the polyp so many of you guys is possible. And, yeah, the ophthalmology one will be sent out if you've done the, uh if it's filled in the the leg and if you haven't, please message the Facebook group and they'll try and get you the link of possible. Yeah, it's just a few more of you guys, if you want, answered the question to the last couple of slides down, Right? Okay, so on the whole, that's the most you've gone for. See some of your comfort E two in the right area. Case most you want to see. So the answer is is actually, it's actually D. Says type five on D. I think this is just something you have to learn. So it does come up in SBA, so Type one is always burns. Never tans. Type two is usually burns times with difficulty Time. Three. Sometimes mild burns gradually turns to olive on. Then time for Israeli burns. Tons with these to moderate brown on very rarely burns. Ms. Type five times were easily on. Then type six with being never burns, turns very easily, and it's deeply pigmented. So this is just something I would learn. There's there's different ways to look at it, but I would go, I would actually go rather than off color, because I don't think that's something that you can do. I think it's better to actually look up how the skin is affected, so I would stick to this description. So melanoma. So what is it? So it's a slowly growing I should have asked you guys actually what we thought that was. But anyway, so it's a slowly growing, locally invasive malignant tumor off up a dermal manana. Sites on the risk is usually type one skin. But I was trying to show you that just because the skin's type one or type two doesn't mean that you're If that skin skins are type 45 or six don't get melanoma. So it's important to consider all of these things and be able to see the different the way that they look on different skin colors. So 1 10 skin types. So the risks are you the exposure, so that would be less time in the sun if you've got another side job or using sun beds on a positive history as well. Family history sometimes so most commonly affects women on their legs, and the most commonly affects men on the trunk. And I tried to find out a bit more. If there's any other reason, I think it's partly to do with exposure the way people dress, but there probably are the reasons on then. The criteria that we look at are changing the major criterias change in size in irregular shapes. You can see this irregular border, and in irregular colors you see lots of different types of pigmentation. On the minor criteria are diameter more than seven millimeters inflammation using and a change in sensation. So I would follow this when you're looking at a lesion out for a look at for a symmetry, Irregular board is to get the color look at the diameter and then look for any exposed or elevated areas that are cracking. Um, so for the management of melanoma other the management part of it is the nice CKs, a British. So she of dermatology part of it, Um, Andi, it's quite complicated. I take some time just to look at it for yourself. But I think the most important thing to remember about this is how you actually use the Breslow depth. A Xavi prognostic measure. So the breath no depth is, um, basically how deeply the melanoma has affected the skin. If the president is more than two millimeters, then you you know, on the excision biopsy, then you would think, you know, is this a stage one? Is it on cancerous or you then move on to a next stage of management. So the management for melanoma is excision. Biopsy on. Then you might do a resection if possible. Some patients might have chemotherapy, or it depends where abouts on their skin is, but they might do a medicine active metastatic to me if you got lymph node involvement on these are some different types off melanoma that you might see, so they know all the same. So this is then take no malignant, which is known as a Hutchinson melanotic freckle on. That's basically when the malignant cells are confined to the tissue of origin, so the epidemics on they haven't gone deeper into in another layer on. But you've got that crawl, which is on the palms of the hands and the soles of the feet. Or it could be under the nails as well. On Do this one. Here is a nodule. A Once you can see there's a raised bumps I've I've circled here. In some cases, the nausea ones might just be another note, and they might not have this outside area. So just watch out for that. So, um, actinic keratosis. So what is that? It's a pre malignant lesion, which is most commonly related to tronic sun exposure. So people that live in hot countries they might have it, especially in the areas of the temple. If you're on placement, you might see quite a lot of this and elderly patients on the risk off squamous cell carcinoma. Developing is 10% at 10 years, so that's tons of worth Knowing, and they will appear is Roth at rough, a rough immitis, skin colored popular with a white yellow scale. Multiple cluster lesions at the site of some experience respond. So how do we manage this? Well, first thing, it's sun avoidance. You can prescribe patient of Flores or cream, and that's a 2 to 3 week course, plus or minus a topical hydrocortisone flare for inflammation. If they've got a lot of influence, inflammation and it's very uncomfortable, you can give topical, different clinic or a topical um, it command. And then the next stages cryotherapy, which is done for these patients on the final stages. Securitizing quarterly, which we talked about earlier. So on to the next one. Squamous cell carcinoma and ballons. So, um, what is it? So it's a locally invasive malignant tumor off the epidemic keratinocyte on day or hand. Or it's appendages, which have potential to metastasize, So balance disease is is known as a pre malignant, so it's before it's malignant. Um, on the risks with this are a UV exposure, a pre malignant skin condition, like at 10 keratosis on that we talked about just now. Leg else's wound scars or immunosuppression, and you'll see an erythematous area where the scaling part or an elevated plus, and it's usually ill defined. So here again. So this is actually a picture of a patient that has ballons on balance. It might just have one isolated area, or they might have. Multiple patients often won't know that they have this because it might be somewhere that they can't see. So maybe their partner will tell them that you need to go to the doctor. And that's by a common thing. It's estimated that every three out, 3 to 5 out of 100 cases of balance, then to develop into a squamous cell carcinoma. So it's really important to pick these up on balance disease. The full thickness of the epidemics is dysplastic, with a typical character, the sites. But these haven't yet reached the basement membrane to become a fully formed squamous cell carcinoma. So how do we manage this? We do a surgical excision. Um, you do. You can do most micrographic surgery, and then if anyone seen that, but it's when and if it still defined and it's quite large, recurrent. What they'll do is they'll excised the area and then they'll take away and areas much they can with a margin. Look at it under the microscope and then we'll see, have been taken away enough. And if they can still see the styles, they'll go back on DTaP's more until they taken out enough away that that has been completely excised, and then some for some patients, but it's not receptible. If it if it would cause, you know, extreme damage, then they might just do. Radiotherapy is one of the patient control rate, a resection. So for bowels, they would usually do a crime therapy using that commode cream or a florist cell, which is a chemotherapy agent on. Then they might do curettage and cautery. Now there is another thing that we could do, which is PTT, which is a light sensitive cream that applies that that they apply. And then they use a laser on that on that area so you can look that up if you want to know more about it. But that's another another way that they can treat it, and then the basal cell carcinoma. Second last light. So what is it? So it's a slow growing tumor off a locally invasive, malignant tumor of epidemic character. The sites on the most common one is like a nodule, a one, but you can also get the message stick or the game or four weeks, which is sclerosing on. Some of them can be pigmented like in this picture. Here, do this pigmented one, and you might be forgiven thinking that's that looks like a nodular, uh, melanoma. But the important thing about this is that you get a papule, which has a fairly rolled raised edge, and that's a really common her buzz word that's used in SBA. So if you see this pearly rolled rays edge on there, also telangiectasia, which means that there's visible small, linear red blood cells so you can't see that one here, but it's it's a bit red on the inside on. They could have come from the outside, and they come over the edge of the pearly white. So one of the risk factors well, his UV exposure, frequent or severe childhood burns the skin type one, so the one that always burns never turns. Just remember when you're ready to think about skin types, try and think about it in that sense, on be a judge. Mail immunosuppression and a history of skin cancer is always important. SPL often throw in. That patient has had a past medical history of malignancy, so that's something to watch out for. And then your management is a surgical excision, so you would do most micrographic surgery if it's high risk of recurrent radiotherapy. Or you could do cryotherapy, curettage and cautery or a topical photodynamic therapy. The previous thing that we talked about, or a topical commit Coumadin and just our final condition, which is a progenitor annual oma. So what? What is this? This is a friable overgrowth off brand elation at the site of my neutral. Most of the patient, it's hurt themselves. They might get this over great that they caught the finger in the door, and then they might have. It might become ulcerated and bleeding on contact. So the manager for this is usually curettage and cautery and us an electric surgery where the skin lesion has scraped off, as I described before. Then they apply heat to the skin surface on Ben. In some cases, if there's diagnostic that out and they don't think they removed the whole, they will do a formal excision. And I think in an SBA common thing which could come up is they might show you this histology slide. That's why I've included there. So if you see something that looks kind of like a cloud or like a cauliflower, I think about it then and then think about Pyogenic granuloma on. This is probably the one of the common ways that it manifests itself is well on the edge of the finger. Great. So thank you very much for bearing with. And we started little bit late, so you want it over. But if you just feel in the feedback form, you'll get the slides and you'll also get a full. You'll get the recording as well. If you want to ask any questions in the queue and a then please go for, I'll just break for a couple of minutes. But yeah, so thank you very much for coming on. Do you have any questions for Frito? Put them in the queue and a function. Now we're on for a couple of minutes. Um, and I hope that that was useful. Thank you so much safe. That was an excellent revision session. Nor is we'll just wait for a few a few seconds on, um and and we'll just if anyone has any further questions, um, just reminded for our next sessions. So we've had a bit of a date change, So if you just check the Facebook group for our sessions on Pediatrics rheumatology on DNT slash urology which are still coming up hopefully in time for progress Test. Please go and attend those as well. And they're they're really going to be great and then double lots of SPS. So please fill in the feedback form. It's really useful for us to see what you guys like and one down. Okay, Yes, I got a question. I couldn't get this slides from the feedback link s o the's lives will be sent to you. Just bear with us if you've done the feedback. If you've done the feedback link, then you're going to slide in due course. We're just getting through it and trying to get them through to us quickly as possible. What is different? Herbal pyogenic granuloma. And I guess your differentials could be a malignancy or they could be Ah, it could be. It could be a malignancy. Another differential could be, um, overgrowth. It could be a wart. So this But I think most for the histology once you've done the histology of the slide, and it's quite obvious what, That that it's a pyogenic granuloma. Um, it is available on metal, but I would, but you But I think you have that you access it by medals. If you just signed a link as if you just fill in all of the feedback you'll get, it'll indicate to you where you're you get it from. So yes. So I got a question here. What's the difference between us? So for the ophthalmology one, the ophthalmology slides haven't been uploaded yet, but they will be uploaded. Very suit. I was just sorting everything out on the slides. You guys, So there will be uploaded, you know, help you. But tomorrow, um, so you will. You will be able to get that That was the difference between excess excision and recession and throw excision on resection. So excision means only a portion off the area is removed, Not the whole thing s so you wouldn't remove the entire body part. Um, on resection is when you can mean it could mean both partial and complete surgical removal. So I maybe I misspoke. Or but it's I don't think that's too important to differentiate for these conditions. What? What I would say is, usually it does say excision with resection might be like in the most surgery where in most surgery, you're not necessarily removing the whole thing in one Go. So you re sect your sector part partially over a period of time over the day, you know, for having me hours it takes. So that's the main decision. The difference between excisional resection. Great. So that's no other questions. Please feel in the feedback form and thank you very much for attending today. So don't say very good session. Really good sites and amazing efforts. I appreciate his age is to, uh so keep That was good. But I don't so ended that. Yeah. Listen, listen. Criminal evening going.