Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

um, so yeah, let's get started, guys. Sorry for the slightly we were just waiting for a sponsor is, uh but yeah, So hello. We are asking easy And we do many different kinds of teaching sessions, whether that's all skis, whether it's finals, surgical preclinical as well as a pre medical. I've just been told the shot out. We have a pre medical division as well. So if you have any financial a spierings medics do feel free to contact us on the premed. Easy Instagram page would like to thank us ponds us. Today MPs, um MPs are amazing organization that specialized in medical indemnity indemnity. Glad announced that we just signed with them or they will be there looking forward to being responses on. But if you guys have any questions at all, please feel free to contact them. Anything about healthcare, indemnity, MPs, you go to people. No, Middle are a fantastic organization that specialize in certificate as well as caution banks. If you don't have a middle of contradictory, So please do we keep a list of certificates and our catcher content on medicine. Quest Med are a fantastic question, bank. They're amazing questions and fantastic as explanations to the questions is, well, we all use them of any for interested in getting a Quest Med membership. Please use or skis 20 for 20% off your question membership. Now we've created an Oscar, the community, which will be posted in the chat or it's already been posted in the chat. It's an open space for people to discuss anything related or skis example for research. So if you have any questions at all, we'll try to answer them. I will direct you in the right direction. And finally, the next light is something that I'm quite proud to announce were announced it yesterday. We launch it yesterday and today the events are gonna go out. It's a new brand new surgical Siris. It's possibly one of the biggest collaborations in the UK, with a surgical collaboration to the UK if not flowing collaborations. It's with British in your medical association burst urology incision. You can National surgical teaching society IHS Well, this one, Walter, a dandy neurosurgical society. All lectures are gonna be delivered by clinicians were at the register. Our level of all these are senior shor. So if you guys interested, please keep a eye out and click going on our Facebook pitch to join us on this teaching. Uh, it is going to be finals Focus. This this teaching that will be in the future. They'll be an Oscar Focus. Surgical Syriza's. Well, uh, just a few ground rules. I'm just gonna highlight the saline points. Please engage in the pool. The session is going to be recorded and will be uploaded on our metal platform. Let us know if you have any questions. Questions were free platform. So please, please, please, please help Sherice So that, um we are able to continue doing this because we we have a free platform. Um, now, I just have a quick disclaimer to put out. This session is a dermatology section. So it's really, really tough to teach dermatology without pictures. All the pictures used to they have been sighted, and I have been referenced. Um, if you have any problems or if you have any, I think that you like to clear copyright claim, please to contact us, and we'll do a best to remove it out of the slides and the recording. But it is really hard to teach. Um, a dermatology. We talk without pictures. Um, we have tried to weigh. Have tried to include a mixture off the dermatological conditions, looking how they look on different skin. Color's this. Well, so do keep your eye out for that. Um, so today we have a wonderful presented. I think it's It's first time on a scale zero, and he's He's been really excited. I've heard for the past few months to deliver this session. It's none other than Nick Phillips. He is the president off, Uh, the Medical Education Society here from from where we're based. Um, and he's unfortunately, he's unfortunately tested positive for Covitz. So this is giving his lecture and from his home isolating, so I'll let you take it away. Well, thank you. Um, just slides. So, yeah, today's talk is going to be on dermatology. We're gonna be covered. Some of the main conditions that are likely to come up in your exams. Um, yeah. So let's get started. Um, no. We're going to start off with melanomas going to discuss how we should go through assessing lesions that we suspect to be melanomas. And then comes the sub types involved, so they are full main sub types that you should be aware of at med school level that is superficial. Spread in nodulars lentigo, malignant on a crow lentigines. All melanomas are malignant transformation of melanocytes those of the melon in producing cells. Um, Onda a few keep its of information here for or melanomas. Prognosis is mainly based off invasion depth. And what I mean by that, I mean, how far does the melanoma vertically invade into the skin? How much it can horizontally spread that that's not really a simpatico full on prognosis, but how much it vertically, how much it vertically invades eyes quite important and may come up as a question. Treatment for all melanomas is version two week referrals to mythology for it to be removed on. That's because of the high risk of metastasis. So how are we gonna kind of identify matter? Anonymous. Use the acronym A B, C D. E for all melanomas, and then you have a separate one off the F G for nausea. So let's go through them. So asymmetry. Uh, what is kind of indicative of a benign lesion is if it's symmetrical. So if you imagine looking at the leisure and folding over if it marries up in matches, that tends to be quite good. Sign lost. If it's a very irregular shape that should raise concerns of possible melanoma. Be border irregularity with benign lesions. It tends to be quite obvious where the the normal skin starts on, but stopped versus where the suspected lesion start to stop with the melanoma. This this border could be quite blurred, and you may not be able to identify. That's clearly so. Look out for that. C is for carol color variability and changing color. So melanomas often have numerous colors that there may be different levels of pigment different shades of brown but also possible purples of possible blues on also to look at in the history, for possibly the patient is presenting with ah, change in in color. Possibly they've gone old. Need by that has changed to a darker pigmented has multiple shades of pigment now on deals for different two other new vial moles. And if you go to a dermatologist clinic, you often hear this kind of phrase of ugly duckling eso. The idea is, is that most patients will have a kind of stereotypical mold that they have on their own body. So when looking at a patient on, they've come in with a suspected lesion that's concerning to them. Have a look at the moles kind of surrounding that area and compare that to the suspected lesion. If that. If the lesion that is concerning kind of stands out and doesn't match up with the others, that is concerning something concerning that should lead you to think about melanoma. And then evolution is that Mallon, um is will grow and change very rapidly, compared Teo benign conditions, adding on the F G for nodule, a melanoma, he is elevated, not a melanoma is. I tend to raise up off the skin and quite significantly on we'll do so. I knew it. You know that that change will be over possible weeks or even days. Sometimes firm eso When is elevated, it's not elevated with kind of bolus liquid. It's elevated with, you know, densely packed cells. So on examination, if you to feel it, run your finger over, it would feel firm to touch on growing. You'll get that from the history on nodulars. Mel names bro very quickly and have very poor prognosis. So we're to go through the different subtypes is explained earlier. Let's start with superficial spreading melanoma. This is the most common subtype on difficult affects younger patients between 30 to 50 on present on the arms, legs, torso. Now, if we have a look at the lesions that we got here and use that 80 matter that we just discussed, um, here's quite a good example. Off a symmetry. If you were to fold it, it wouldn't marry up very well. That's quite concerning border. Here. You can see that aspects of it where the where the lesion is. You can't exactly tell where normal skin kind of stopped in this on this lesion starts, and you can also see that PSA lately with these two here color With all three of these, you can sit down multiple colors making up the's melanomas, which is quite concerning and then d going with, like, different than normal. Most present on that on that patient. If you have a look here, if you compare this to what the patient has here here or even up there, it's It's quite obvious that I'm that it isn't that isn't normal for that patient, and obviously you'd ask that in the history. How is this of all? Does this recent changes have been growing? Um, if we compare this now to nodule, but this is the second was comin Subtype of melanoma have importantly here has the worst prognosis on it. Aggressively in babies. I'm on metastasized very, very early. So it's quite concerning, um typically effects middle aged individuals something exposed areas on exams, love to kind of describe. This is a red or black lesion. You know that it possibly bleeds or weeps. So here you can see that that kind of that black color tour the red color to it. And if we add on the F G, which was the acronym for specifically nodular enormous years elevated. If you have a look at all of these, you can see that they've elevated quite significantly from the baseline of the skin firm they look firm to touch. And I think this is quite good example here off what I mean by it doesn't look very bolus. It doesn't look like it's filled with fluid or puss. If you depress that, that would be very firm to touch. And you would expect these the's lesions to grow over space of possibly, you know, days, weeks. It's a very rapid growth, comparatively to other skin lesions that you might find, um, if we have a look at my auntie, go malignant melanoma at This is something that's called in sick, human and Omar, because it's confined to the epidemics. It doesn't really invade that much vertically. And if you remember back to talk about prognostic factors, that means that it tends to hold quite good prognosis. It typically affects older patients more common with chronic sun exposure. It only really affects photo types 123, so it tends to be found mainly on Caucasian skin. You won't find it often on a darker skin turns, and it tends to be quite rare as some type of melanoma, anyway, the purpose of exams. They'll probably present this in a in an older Caucasian patient that's been growing over space of time. Um, equal 20. Just melanoma on this is overall, the least common lesion. However, it's the most common in a dark phenotype, so so you have to be aware. But for that reason, so if you're presented on with patients of those demographics that should be off. That should be the forefront of your mind. So it's characterized by carrying on the palms of your hands cells of your feet on. But you can also get it underneath your nails on your nail beds. And when it does so, it presents with a selection of different signs so as convenient. You often get these kind of longer tune a little lines of off pigmentation that could be seen really clear here. And another key signs of the cat for Is that Hutchinson sign now? Uh, unluckily, I I couldn't find a really good foot off it, but what you'd expect is he'd expect this pigment to kind of extend pass the nail fold border so you'd expect it to pass from the nail bed onto the skin, um, onto the skin around here. And that would be a Huntington sign, which is indicative of a cruel antigas melanoma. So what I've done here is that bizarre SPS, but I've just got a few kind of basic stems describing how possibly you'll find there's subtypes of melanoma explained to you in the history off one of your SPS for an exam. So just taking a bit of time to think about it and on your own. No need to go to the pole for these ones. But the most common man, um, subtype, typically affecting younger patients that's gonna be superficial, spreading the one that holds the worse prognosis. Be aware of that F G acronym that's gonna be nodular, and those will be red black being might possibly week or be bleeding. Those which exposure on tend to be a more elderly demographic. That's going to be lantigua, a malignant on those which are more common in dark of Phoenix. Fights in effect, the palms, the soles in the nails that is going to be a cripple. Anti IgE antigen us. So let's go into some SBA is I'll give you time to read through. Think just over half of you finished now. So most common answer was be No, that's correct. This is just one of those one of those, uh, fax that you need Teo know. So, uh, that the prognosis was worse with marginal melanoma. That's because the fact that it invades very aggressively and the testis size is very early says we want to the next one. Okay, so I think most people got the right answer here. That is a cruel and even this melanoma. So let's just go with the key aspects. I'm off the history here. This is a patient of a dark prototype presenting with a lesion on there on the toe S O. That's the right kind of demographic. The right region is body on, then presenting with those longer TUNEL bands a zoo well as involvement of the nail filled. So there's a few of the key nail signs as well. Yeah, all righty. I think the majority of people are I answered this one correctly. So let's just go through the different aspects off the history that are leading you towards this. It's in an area of sun exposed skin. It's on a light of photo type of you can see from the photo are going from that a T e kind of assessment for melanomas. It's indicative of a possible, um, Alan Oma on us to the age is a younger patient. As to that makes it less likely to be m t go malignancies toe it is a stupid fish is spreading, man of So now that we talked about melanoma is that still about something non well known? Cancer's starting off with a B, C. C. The's are really, really common. They're slow growing cancers which locally invade. They don't tend to metastasize that much. So don't I just don't tend to our C to treat them as as quickly. A Z would imagine Oma do that kind of low risk. I believe that they actually start most, um, star around the hair follicles. Actually, there's numerous subtypes, however, for the purpose of kind of med school example at med school level, that nodule is the most common. And that is there the presentation that will usually be shown to you when describing a basal cell carcinoma risk factor, intermittent burning. And what do I mean by this? Um so intimate of burning is kind of like what will happen to me over some are. So I spent a majority of the year, you know, in Wales, where it doesn't we don't really get that much sun. I'm not going. I'm not getting that much. You the exposure and and possibly you know, we get one random heat wave burn like three times in that week, and then I go back to our living in darkness and rain. So it's that intermittent burning rather than a continuous exposure. Such a living in Spain or somewhere where you actually get to see the summer been No. So, uh, because of that association with with UV exposure, you're going to get in some exposed areas, it's gonna be slow growing. There often describe it's kind of skin colored popular. He may get a level alteration. I think you can see that here on the image on the right. And what I mean by ulceration is that it's lost the top layer of the epidemics. Um, typically, they tend to either be pink, um, or matching that the kind of the pigment off the patient's skin tone. So here you can see it's It's pigmented was here. It's got more like an erythematous. Look to it, um, a couple of key key aspect or key features. Rather off be CC's of distinguishing factors are these kind of rolled edge is surrounding the board of the lesion on. They tend to be described as almost purely because they've got that reflected that reflective kind of liked thumb on also, ironically, not in either of these photos here, but you'll get a lot of air to language Teyssier associated with be CC's, which help distinguish them from possible um, squamous cell carcinoma as treatment options, mainly surgical removal. Sometimes they may use a cryo therapy or or topical and topical creams in the top creams that they use of these kind of chemotherapy like creams. Teo prevent the South perforation and all that, but surgical ruble will be will be the main treatment option, and usually it's safe. Safe. Call the answers if we compare this night to scream cell carcinomas. Now, technically, these are invasive scream cell carcinomas on. This is what we mainly think of. When you say in a sec on, we'll talk about why it's important that we that we were there the invasive version a bit later on these comparatively to a B C. C. They can metastasize, Um, and some of the risk factors are that it's the cumulative UV exposure. So again, these will be in patients that that have worked abroad, lived a board, you know, places where you will get that continuous some something that med Med school questions love to throw. Use this kind of immunosuppression aspect of the history of patients with them. SCC's, I think, with a believe it's renal transplant patients, the most common cancer that you could get associated with. That is an SEC. So look out for patients on long term steroids patients who have had transplants. It's also associated with smoking. Bowen's on actinic keratosis Those are two pre malignant conditions will talk about those in depth of it later, but just for now know that they are risk factors for a SEC features again. Because of that, uh, that risk factor off UV exposure, they'll be on some expose sites. You can get this kind of thick and picture around around the base here, so you to feel that I feel very, very sick. Skin that. And then you can also get this. It's not. It's like these containers homes where it will grow. You'll get these out strobes at crossroads of like this. Um, yes, I carry it into form. What kind of like a whole one, I guess on others you'll get like a plaque plaque like lesions. Possibly quite exam it. It's what you can see on the gentleman's forehead and, um, on the left than what I mean by plaque is that it's it's raised the leakage in his rays, Um, on another common site just to be a well is that that they are often in exam purposes presented on a leper when comparing it to be CC. So, uh, if you see a lesion that is suspected cancer patients lip, it's more likely to be an SEC just because of how they like to style the questions treatment, surgical excision. And that's because of the risk of metastasis compared Teo BCC. So going off what we just discussed, uh, let's have a look at this SP A Yeah, all right. I think the majority of people actually got the right answer here. So let us go to your on. Just go through some of the history here. So we've got on older patient the lesions on an area which is commonly exposed to the sun on Let's have a look the lesion itself. It's quite well to find you can note your telangiectasias on if you have a look at this border on the upper aspect. It's got that kind of that early rolling raised edge. So all of those signs of kind of indicative of a basal cell carcinoma. So if you compare that to this condition here, Yeah, yeah, I think a lot of people are getting the correct answer here, So that's just done. I think I just have a look at the history was remained a, um, pick eruptions. So we've got an elderly patient with a lesion presenting on an area that gets a lot of sun exposure. It's been growing quite quickly relative to what you'd expect off a possible, um, BCC In the history itself, the patient has had a previous kidney transplant. Eso they That's putting them at, um there and, you know, suppressed on. Then if you have a look, the lesion itself, it's gonna come up a thickened aspect to the base here. And then you've got that kind of cutaneous horn forming, which is again indicative of squamous cell carcinoma. So let's move on to the precancerous lesions and actinic keratosis and bones that previously mentioned so actinic keratosis. This is part of the thickness atypia so kind of, uh, change. It damaged cells and cells that, uh, incorrectly developing through only a third of the epidermis. And this is quite important because this is what differentiates it from bones. Disease is the fact that a K only has that that partial thickness, um, you get it do to excessive sun exposure and nuvi damage on get may progress to the bones so it may progress to like a full thickness of the epididymis on. Then it possibly could invade past the epidemics that should make it in SEC and invasive SEC or possibly a major self result, or remain as it is. It's more common in elderly patients with like to skin types. Because of that that increased your e damage and exposure on. It's kind of described with quite a rhythm it', quite scaly, quite widespread, on be found on areas of quite like sun exposure, so you'll get it on the face. And ironically, you know the feet. However, the way to think about that is when patients are possibly living, you know, in Spain or where they actually get a nice weather and you can wear sandals or flip flops or sliders or whatever you kind of want to wear on your feet, and you get then that that sun exposure. So if we compare that to Bowen's disease, which is screaming cell carcinoma in situ. So has an invaded past. The opportunity. This is a full thickness tear in comparison. Teo Actinic keratosis you you know you can develop a Bowen's disease lesion you know on its own. Or it condemn eloped from a previous area of like actinic keratosis again. Due to that risk with an UV exposure, it's gonna be more common in elderly patients on for the purpose of exams it's often described is an area thumb it a scaly plaque S o. R a Z lesion, and it's often quite a symmetrical. It was much, very well. It's a precancerous lesion, obviously to sec as his um, actinic keratosis on treatment contained for him those topical chemotherapy like creams, cryotherapy where they choose to freeze it off, or exercising them depending on the area. If we compare this now, Teo correct acanthamoeba again linked to sun exposure. So you find in old populations. Interestingly, about these lesions is that grow relatively quite quickly in a process of a few weeks, that benign. But they grow quite quickly, and actually they can regress by themselves spontaneously. Just leave a scar, having a look at the lesions themselves. They're described as having this kind of volcano or creator like shape that could be seen quite well here with a characteristic plug centrally. Now, if you have a look at these two images here, you can see that they can be quite hard to distinguish from the cutaneous forms you might find in a sec. So often, Li often Li often li they require excision. I mean, you look a look, a plaque you. Now this tends to be a diagnosis of exclusion, so you'll run through a list of the French is And this this one will be, uh, will be last. It's pre malignant to sec on. It will present us a white kind of thin plaque that will be found in the wrong mucosal on the tongue. On importantly, it can't be rubbed off, because if you have a look at the image here, you can miss. Take that for a candida on oral candida. A patient can scrape up last are like a plaque you can't scrape off. It's more common in smokers, and that makes sense if you think about the location of the carcinogens from inhaling that smoke. Um you going to want to biopsy these lesions on treatment tends to be excision on using a C or two laser esteem. A big name I got, like the atom ology of that. It literally just means readiness from the fire. So what is it? You get it from chronic exposure to heat source, and it's that infrared radiation that creates the solution. And it's a pre malignant lesion. Teo sec. Now, don't worry. If you use you know, you know, if you use the old hot water bottle or have the heating on in your house, you're not gonna get this. This is only really found in seriously chronic exposure to heat. Source is so you'll find it. Typically in the stem of the question would be a patient was like with chronic back pain. Eso They're using a hot water bottle continuously of the same area on multiple times that but throughout the day, or possibly elderly patient who likes to sit by an open fire. You know, maybe I've got, like, the special chair, which they will sit by and how does it present? It's typically describe is an erythematous rash on you get this kind of lacework on fish netting Appearance. If you have a look at on this patient, you haven't really got that that erythematous aspect to it. But you can still see that clear lace working pattern. This is treated literally despite removing that heat source. So telling the patient, Teo, you know, stop using water bottles for appeared on this this'll lesion will kind of regress on its own. So going up what we've just discussed let's have a look at the SBN. So really just a quick, uh, plug before people suffered in the feedback form. Join us for our psychiatry session on Thursday. So that's divided by Allen and myself. Solid. It looks like a lot of people getting the right answer here. Um, it's a couple more seconds. So the other people I know how's it again? All right. So, um, if we just have a look at the lesion, it's ah, sun exposed area. Having a look at the stomach, the question itself. We've gotten elderly patients X scaffold. I threw that in there because, uh, people who work in construction will get a lot of UV and sun exposure. Jane, There Korea's. It's being open. Call essence skin change quite slow on, but if you have a look, a lot of a lot of the skin is damaged, so it's it's really across the forehead entirely. You could argue that there are areas of skin where the lesions are bit worse, but because it's so generalized, this is indicative. Off. Actinic keratosis is so moving on now, too, comparing necrotizing fasciitis desktop identical Rios Um, because these two conditions can sometimes be confused with medical students. And I used a computer all the time as well, so it's just kind of go over the basic points of the level off what's expected at med school. There are multiple types, but there's only two types that you need to be aware of. Type one, where it's caused by a range of different manner robes. And this is the most common subtype. Our bet. You've also got Type two, which is caused by streptococcus pyogenic. That's the that's the organism that the Medio love, like daily mail. Always how it was like, you know, are flashy. It in organism are that that's that one just just for their knowledge, their risk factors. I like to split this into to kind of areas you're gonna have, um, risks associated with the barrier on detection. Ah, aspect off the skin being damaged on. Also, the patient being immunocompromised on that for more susceptible to infections. So anything that damages the skin itself, that could be burns. Trauma surgery on. That's going to increase your risk. Diabetes now, especially sdo SGLT two inhibitors on. That's because now my pharmacology isn't the one, but just basically in kind of like laymen terms is that it moves the glucose into the urine on. Then, if you've got a patient who postvoid really will be the kind of dribbling or possibly incontinent, you're going to get a lot off year in with a high concentration of glucose. That puts the patient about a really, really high risk off developing and equitized fasciitis. And that's actually right in this common site or bit is around the Perineal area, and that's actually called for years. Gangrene. And then you have other aspects that will affect the immune system of patients. If they are, you know, um, you know, suppressed you to surgery or long term steroids or if they're IV drug users management very important to know our agents Surgical deprive mint and IV antibiotics IV antibiotics Tents depend on local guidelines, so you don't really need to worry about which ones in particular, but do know that you need to treat it urgently with surgical department on IV antibiotics. So if we have a look at what it what, it compares ent like it will present very, very acute be, and that that is one of the defining aspect or bit this can. You may get a rash or lesion of develops over a space hours. It's a very rapidly progressing condition. It can often be mistaken star presenting with a cellulitis kind of picture. But the key difference between this and cellulitis is that that rapid history and also the amount of pain that the patient reports on in necrotizing fasciitis, it may present looking a bit like cellulitis to begin with. But the patient will be describing the pain to be much, much worse than what you would typically expect on the patient may be also systemically, and weld signs of sepsis will present possibly with a fever, and the rash itself requires a rhythm notice rash on. Then, after you know, after a while. Then it will develop into that kind of necrotizing phase as it Azul get these. These black kind of borders is that the tissue dies. You get a lot of puss on, it will invade. You know, you lose some of the skin, some the layers of the skin. You'll get that puss Deemer associated with it, and you may get cracked us as three organisms release gas. Now if we compare that to pyoderma gangrenosum pyoderma gangrenosum is an autoimmune related condition, and you'll get these painful else is relating to infiltration of neutrophils. Most commonly, it's Did you pass it? But often the purpose off exams. They'll include a patient IBD or rheumatoid arthritis cause autoimmune conditions. Not always, but they they can often present with other autoimmune conditions. The diagnosis is usually clinical, and management is quite important. It's oral steroids do not treat it like necrotizing fasciitis because they're actually worse. And surgery surgery actually worse since the disease considerably, Um, and if we have a look at how it will present, the most common location of present will be on the lower limbs on dot present as these kind of small postural those red bumps, blood blisters and what I mean by a blood blister is kind of like an area of skin, which looks a zip. It's filled with with fluid, and it will have that color of a dark hematoma look. Classically, it may be described toe have this this purple like border that tends to be reasonably specific toe pad, emmick angry or some on. Then over the course of a few days. Whatever it may, it may then become necrotic. It doesn't always for coming across it, but it might do. And that's what you're seeing here when you've got that that that blackening of the tissue, you get the puss when you get along that. So if you were to compare those two conditions side by sides, necrotizing fasciitis, that's that's an infection, and it will affect all of the fascia with sub cup fat as well. It's gonna be a much, much more cute picture of the space of possible hours. On it can resemble cellulite deaths in the early stage, but you're gonna have possible, you know, a septic picture because there's definitely going to be on chronic areas to it, and then treatments agents, surgical deprived moments on D I v. Antibiotics. And if you compare that Bentyl pyoderma gangrenosum, it's a non infectious cause only affects the donor. It's it's going to be a lot slower, and it doesn't always present with that. With that necrotizing aspect, it's not necessarily gonna turn necrotic on. Then you got that on the important aspect to remember that it's treated with or or steroids treating the patient with surgery will actually losing their condition. So still about a few other infections. Earlier, I was describing necrotizing fasciitis to present with with a picture of a possible Sally life, too. So let's let's just described that in a bit more depth. Here. Cellulitis is a bacteria infection of the lower Dermus and subcutaneous tissue. That's quite important to remember, because that's the different different checked it between cellulitis and syphilis, which we'll discuss, uh, in the next couple of slides. Commonly, it will affect the shames it can well, not the common areas here, And if it does fact a limb, it's probably gonna be unilateral. It's unlikely that you're going to get it bilaterally, and you can see that in all of them. All the images I've got here is This is only on one of the one of the shins. It will look very erythematous. You're going to get a lot of swelling with it. It's going to be painful. It could be quite warm to touch. Sometimes on patients can sometimes present with a fever. They might not, um, quite important with this one less so. But if you have a look at the lesions off for the two, uh to right images, you can have the look on. But it's quite hard to pick out where the where the normal skin is on where the skin shows features of cellulitis. It kind of merge is quite a lot on that is something that differentiates between, uh, cellulitis on Aricept list. How do we treat it? Flew cloxacillin. That's gonna be a first line. If the patient's allergic to flu clocks, you want to use caress myson on. If they're allergic to penicillin. Onda pregnant. You want to use for it from I said. That's quite important to learn that does commonly come up in there in MCQ. So let's talk about our civilised. This is basically the same thing as cellulitis, but it only effects the the upper layers of the upper Dermus. So what that means is that it will present with a much more defined border. You can see here that it's much easier to say where the healthy on, Um, where the where the skin showing Aricept Lis, where that border actually is. You can see it very clearly here at the bottom, on treatment of choice flu cloxacillin again, and I'll follow a similar kind of pathway to and to cellulitis because they're basically course by the very similar things. If we compare that to a restaurant, arrest Prisma, I can't really pronounce it. But let's move quite important that you learn what it's caused by the sometimes. Throw that in a question. But how does it present? That's the important part. A well defined Pinkel brown a lesion. Possible scaling. But the key aspects here are going to be where it's presented thing. It's gonna either present in the growing or Exelon commonly, so the arm picked on sometimes what they like to include in the standard. The question is, Underwood likes examination, which is kind of like this for the rest of the blue like kind of thing. It shows up with this cold red and look to it. Management. You're gonna want to use topical antibiotics or antiseptics. First line, and it's more extensive. Or if it it doesn't clear up from that you want to use oral Ritalin Mycin. They commonly actually will ask that that second line for more extensive case is off or electrolytes. And so So don't just write that off. Do you try and remember that? And you want to use that possibly in these conditions here, where it is a bit more diffuse on down. You know, areas here have ulcerative. You've lost that area of the abdomen, so you might want to treat it a bit more aggressively. So going off what we just discussed Have a quick look at this and see you. No, just get a little bit longer remaining people already. So they just have a look at the possible options here. So cellulitis you'd expect a much more kind of expect the Board of the lesion to be a lot more unclear. This is quite well, well defined lesion on Aricept list you'd expect it to be. And let's not a steep of a color. You're expected to be a bit more right? Uh, the rest from us de it Expect that to be located in the armpits or possibly in the groin. So this isn't really the stereotypical area. Now let's have a look at the history itself on Do. This patient is on. This's patient has also typical like this. So they've got autoimmune condition, which puts them at risk. That's one of the risk factors or associations. Rather with high glycemic angry of sun on, they are systemically well on. Their observations are normal. You're not really getting a septic picture. You're not getting that cute picture, which would need you towards necrotizing fasciitis. So this is a pilot in American Gruesome. Yeah. Give a couple more seconds, people to Arkansas, Right? Cool. So let's just go through that. So I know some like stem to begin with, So we have really patient presenting any s. So this is an acute picture. They're diabetic, puts them at risk off mecca testing for shite. This on. It's also in the parent, um, which is the most common area on now. This patient is presenting pain swelling, but the most probably the most important part of this stems here is the fact that the patient surprised, you know, this'll this'll lesion has grown significantly over what must have been a very short period of time. Because that acute history, the risk factors on also the area that's gonna pointed towards necrotizing ashamed desk just took a shower. Just give a minute. Uh, read through. Yeah, I think the bulls have been okay. Uh, so having like this one, we've got a patient letters. Have quickly have a look at the diagnosis. We've got, um, a beast patient presenting with the lesion on the left leg. So obesity is a risk factor for cellulitis. It's unilateral on one of the legs. It's an erythematous rash with swelling. It's warm to touch with the patient swells. You're not concerned, but ah, necrotizing fasciitis. So usually first line would be flu clocks. However, this patient is allergic to penicillin. So then you're either going to use a wrist from my sin. Of course, from my sin, Uh, this patient is pregnant, so you're going to use the restroom recent. So let's move on to acne vulgaris. So this is what most people kind of picture when you when you say the words acne on There are lots of different aspects that it can result in the developing development off acne. Three areas that are commonly affect are the face in, you know, more serious presentations. It might affect the neck or the back and some of the features that it will present with these come down. So here I'm not sure if you can see my cursor, but here these are What described is open come down. So there's a like blackheads waas. Here's some kind of closed one's which, you know, got that kind of like, um that that aspect to the picture. In most serious case, you seriously cases you'll get kind of popular passed rules. You get pitting and scarring that can be seen quite clearly. Hear some of those, um, those populace and postures when you will get that back. That pitting type of scarring management back is really important to learn, because it really does. It comes up a lot. So first line, uh, well, actually, you're gonna go through in kind of like a step up bladder. So firstly, you're going to try them on a non antibiotic topical treatments, A topical retinoid to do today. Then you'll move onto combining that with a possible topical antibiotic. Then you move on to or landed our dicks. What's traditionally uses tetracyclines, however, if that's contraindicated, such a the patient's younger than 12 years of age or the pregnant, you're gonna want to use the restroom mycin. Now. If the patient's female, you can use the complaint of the combined oral contraceptive pill instead off or antibiotics, so that can replace the third line and then your last line of defense. Then it's going to be oral. Ice attracted know, and that's kind of like a refined vitamin A tablet that can only be prescribed by a dermatologist. So per, say, Let's say that, um, MCQ says that you're you know your your GP or you're in the GP surgery. You won't be able to prescribe that only a dermatologist can do that. That's because that really high, highly teratogenic drugs so moving onto your ization and you may see it turned as acne rosacea in some of the older textbooks because they used to think it was, um, it was connected. But then they figured out that they're wrong, so don't be. But if you see acne rosacea in an old textbook, I promise you're not lying to you. It's just numbness. Visitation. Now this is a chronic immune condition on it commonly presents it flushing. Now it is really only I think 90% of cases are in photo types 1237 kind of Caucasian demographics. However, the symptoms that that you'll find in in patients off the darker phenotype will be flushing on that flushing is theme most common, um, symptom that will present. So, really, if you see that in in the history of actually kind of ringing bells of authorization that flushing abusive associate it with sunlight, exposure or alcohol in more kind of severe cases, you may see at this area tentative rash developing with postural is and are kind of like red populous that you can see here on affect region regions off the forehead on been knows the cheeks areas of sun exposure. Now I want you to have a look at this gentleman's nose here. Have a look at the the the kind of skin thickening on you can really clearly see the pores so that that that that widening of the pause on that's called, um, rhino femur. That's quite do you only get that in more and more serious cases, but that is indicative of this condition. So if you see that just straightway go to is Asian, um, it may also be associated with time dictation. So we saw that with B. C. C's, but they are. You often see this. And recessions. Well, management, mild symptoms talk metronidazole more severe disease. That would be horrible tetracyclines. How do you know the difference? Possibly they're just presenting with flushing. Or, you know, they haven't tried any treatments yet stopped around topical metronidazole or comparatively then in the stem. If includes a history off, you know, they've tried first line meds, didn't work or possibly on the right femur. Then you're gonna want to just start them on the oral tetracyclines telangiectasia as a whole get treated with the laser therapy that's not unique to just rosacea. But obviously, as you do get tasty with rosacea, see, then he treat that with the with the laser therapy. So going off what we just discussed Let's have a look at this and CQ Yeah, already think open up people. So you get to a minute. Computer seconds already. So let's go through. Let's go through the different options. Yes. Okay. The patient has persistent acne. You can see some pitting here, so they're gonna want to move up the ladder. So they already tried. All right. They tried topical treatments that tried combined topical treatments of antibiotics and Gretton. Retinoids. So what are the levels beyond that? So, you know, just rule out a few, so rule out early isotretinoin or in because you're the GP. You're not gonna be able to prescribe that. So you have to rule that one out. So then you have the options off tetracycline combined or contraceptive. Um, you would only use a wrist from icing if the patient was pregnant, but the patient isn't pregnant on the patient is, you know, 20 years of age, so there aren't really any contraindications to using tetracycline, so that leaves it between B and C. So if you have a look at those, the patient is a wheelchair user, and that is a complete contraindication to ease off, um, combined or all contraceptive pill. Due to the risk off are DVDs and clocks. So that leaves us with the answer off tetracycline. Um, moving it on now to psoriasis again. There's a few subtypes, but for med school we're only going to focus on a couple of thumb on. They are chronic autoimmune disorders. On the main one is the plaque. Psoriasis. That's the most common you get scoped psoriasis. Sometimes it's a sack broke subtype, but often gets kind of group. Does there plaque psoriasis on? Then you get a you take psorisis the we'll discuss later. So with plaque psoriasis, you're going to get these well defined red plaques. So plaques meaning that they raised on You'll get the silvery scales. You can see that in quite a few. The examples here actually think walls, and I have some of that scaling to extent now. If the patient doesn't have scaling at that can occur on that can often occur if the patient is. If that's psoriasis is well controlled, so you know, don't don't worry it. Possibly if it does have that that that raised well defined border. It's a very primitive plaque. It can still be psoriasis, areas that it commonly effect. I'll be the sacred scalp on the extensive surfaces. Um, having a look here. You can also get nail signs now. Gosh, your current. Everything's popping up on my screen. Sorry, right back so you can get pitting, which is what you can see here is if someone's gone, you know, aboard pain or something like that, like just shrank the nail or something, like poked it where you get that little bit of like a opening. Then that's pitting on. Then you get a nickel isis, and that's where the nail itself detaches itself from the nail bed on. Because of that, you'll get discoloration were improved up the nail, and it'll be more of a yellowish town. So if you have a look here, what you'd expect is more off white, kind of nail going across here. But what you'll get here now, going a bit deeper, where where typically shouldn't be. It's more the yellow color. And that's article Isis. Um, now, quite importantly, if a patient has nail signs of psoriasis, that's really associate it. This quite quite a significant association to then, um, an increased risk off. Sorry. Attic. Arthritis. Now, I think we've already think this has already done the rheumatology talk, eh? So we're not going to discuss it here, but just have that awareness that possibly if they have got mail signs of psoriasis on day are at increased risk of having the the rheumatological and arthritis associated with it. Now management. Most patients will be on vitamin D analog, both chronically and for acute flare ups. But for acute flare ups, what will be used will be potent corticosteroids, and you're use that in conjunction with the vitamin D analog. But it's separate times of the day, so use one in the morning and then use the other one at night. You're gonna try that for four weeks. If that isn't successful, then you just double three usage off the victim D analog. Quite importantly, psoriasis is just a 44 week break between corticosteroid or use to to the effect that it can have on the skin. So just have that at the back of your mind exacerbations. That seems a bit of like it drain, but doing it because actually, it will either come up as a question on its own, or it will be hinted at in the stem of the question and make answering. It is so Jesus. So you're not gonna bother, like, read and, you know, all the different drugs out, but just a list of the key ones there, um, but importantly, are actually give you a little well, just trauma alcohol, drugs. Often they like to kind of change, you know, anti hypertensives or anything like that, or withdrawal of systemic steroids. Possibly coming off a long term steroids for on know like Kim are some that are on then strap infections are other mean trigger for guttate. Psoriasis says so. Gouty It's psoriasis typically affects younger adult often Children actually on diesel present with teardrop. Help yours on the trunk and limbs. These air considerably smaller bone, chronic plaque, psoriasis that we just discussed. And if you have a look here, you can see that that they're considerably smaller. You still get some of that scaling on, but it doesn't. I'm not sure you can see in the picture here is well, but they are still do Get that that area stomach has changed that that pink red plaque forming. Um, commonly, you'll get a history of a child with, you know, like a sore throat for a couple of days, and then they're coming out in this. This the fuse rash parents really concerned. And it might be a point. You towards guttate psoriasis treatment is just reassurance. Possible topical millions help us, you know, itching. But it will resolve spontaneously within, like, 2 to 3 months. So pityriasis rosea a Now, this is a bit like a rogue condition, but they do like to include it sometimes s. So I'm only going to cover like the bare minimum of it. Otherwise, it's just gonna get really complicated and, like, really boring for me to just call it list down. The'keeper's aspect office could be linked to human herpes virus. Seven. On initially, you'll get this Harold patch. Now, Harold Patch is quite a large like like a pluck type thing. Forming that like to be under the torso will be, you know, on the legs. Most commonly on this, this patch will be considerably bigger than the rest of the lesions found across the body. No. Uh, but then I think it's like 2 to 3 weeks. Commonly, after that original lesion, you'll get these much smaller, scaly plaques appearing across the torso that back Andre the sometimes like to include this, but they can present in its food tree pattern on. But if you're interested, I think it's I think it's the language, hard lines or something, or the language lines. And it's all about that. The tension lines found on the body. So the mirror, the tension lines forming this kind of his Christmas tree pattern off, which I couldn't really find a good example of. So it's clearly not that common, but, you know, they might include it. In the stem of the question, I think I've seen a few questions where they describe it as a Christmas tree pattern. Management is that it's It will self a ball self resolved in 6 to 12 weeks, so it's mainly just self limiting again. You can treat that with topical millions if they if they are complaining of an itch but the purposes of an exam, you know it's self resolves, supplementing pityriasis for psychology. So it used have a different name, but that's not new. New, uh, us again about if you're looking in old textbooks, don't worry. They're the same condition. Uh, they are caused by fungal infection cause called muscle Azia, for for that's quite important. One talks remember, they do like two hour, sometimes ask you that on, but that that fungus does cause other dermatologic a look Ishan, which will discuss later. How does it present scaly patches with different colors, so it can either be hypo pigmented pinks browns? Commonly, the history that you'll get is your have possibly a younger individual who's got a holiday where it's being humid on. They've developed this kind of change, often like a hyper pigmentation across the body on. That's because it's the holidays provided a perfect environment for him. Gross off the fungal infection as opposed to, uh, you know, living in Cardiff. How do you treat it? Topical anti fungals or a ketoconazole shampoo if it's a large area, so it's quite a few. Sara's so possibly here. You use the topical anti fungals because it's quite limited to the areas of which it's affecting. Obviously can't see the rest of the patient, but here was across the entire shoulder. You might be inclined to use the key to campus on shampoo. Second line, then, is our trick. Carrots up, moving on now are a team and a dose, um, versus erythema multiform a healthy man of those sun. This is information off the subcutaneous fat. There's a little like pneumonic that you can remember if the cause is where no is idiopathic drugs. Comic penicillin, often obeying oral, contraceptive, pill or pregnancy? Either one can be triggers, as it's like soccer doses on you is for you see, But it's actually just IBD. So any form of you know either currents, disease or also difficult like this can be triggers on then. M is microbiology. So TB or strep infections commonly actually on the like using strapping infections a lot in steps of questions management. No treatment, which sucks because it's actually quite a painful condition. Toe have, apparently, So you don't treat it. You just follow up S O what does it actually look like? You're going to get these bilaterally on the shins. Most commonly, you can get it on the forearms, but shins are the most common region on. You'll get tender erythematous on, no chills appearing, and these will be painful and they'll be present for a couple of weeks. But then they will be real. Self resolved patients may present with a fever they may present with joint pain associative but throughout you're going to get this this picture off. Multiple non. Jules Chris across both off the lower limbs now, comparing that to a theme amount of form A completely different. This is a tight for hypersensitivity reaction commonly caused by HSV infection. Now you will have this, um, often than not describe his target like lesions. You can see that in these two samples Really, really clearly where it looks almost like, um, like one of them are tree. Tolerate something. Uh, it may be an area Semitism possibly on, like to skin tones, But just be aware that that future might not always be a big present on the areas that it will tend to effect will be the hands or the feet, but more commonly it will be the hands, and then it will spread up the arms onto the torso. And you can see this this spreading on the forearms here in more severe cases, it may affect the lips causing them to us rate. They lose the top layer, the abdomen, CBC It becomes very for be very painful for the patients. I haven't included it in its talk, but erythema migrants, I always confuse it with erythema multiform because they both have erythema on begins M on our thing about a form A is described as target like allegiance. See, my my grands is described as a bullseye lesion. So how you gonna differentiate them in an exam? Seem a multiple May they're going to be really, really small multiple across mainly the hands and feet possibly go up the arms. You can see in all three of these examples relatively that really quest erythema of migrants. You're gonna get a much larger lesion, possibly over like the abdomen, maybe on the legs on those, of course, by tick bites on Dwell are indicative of limes disease. So really, it's that size on the frequency of wave off. How many lesions you find on though the past it different cheating. So it's at seven s k. Yeah, Uh huh. Just give our that longer. All righty. So let's just go through the key aspects of the history here. We've got patient who has gone, undergone a recent change, their medications on importantly, they've been started on beetle blockers which are one off. The common triggers are common triggers of psoriasis exacerbations Now, patients don't always have to have psoriasis before. Possibly these triggers can be the the beginning off investigating their condition. Eso They've recently been started on a beta blocker on. Now the plaques themselves that erythematous plaques with well defined borders with some silver skin that is tax book psoriasis. That is, that is the tax book expression. So surprise, surprise. It's it's psoriasis. Um, moving on. Right? All right. I think the joy people here actually got the m the cracked answer, which is pityriasis rosea a selection scope over this. Them, uh, is a younger patient presenting with originally a singular large lesion on that has not progressed over a couple of weeks. Two new Ms lesions across the body and what I was trying to do here was describe it that that Harold patch initially on on then the multiple lesions which you get through that psoriasis batteries here. You're not getting the the new machine. Uh, hyperpigmentation be associated here. You're not going that target lesion, which we get with everything with not a form a you're getting because it's it's quite it be. It's not the right type of lesion again for everything, Manager. Something about the correct kind of aged category you'd expect to find in on, then the psoriasis. The key difference here is the fact that it's that one large one on. Then the numerous little ones develop in. All right already. So I think the jury people got the correct answer here. So let's just go to the stem. The question quickly. We got a patient who is pregnant, presenting with by electro as antis nodulars on both of his shins. So this patient has been feeling under the weather recently as well. On what I was trying to get out there with the sore throat is that strep infection, which could be one of the triggers for it in men. It's awesome on comparing that with the pregnancy, which is one of the risk factors on also the description of the lesions itself. That's quite indicates it. Just one more SBA before he went on to some of the other injections. Just a few more seconds. All right. Um, yeah, this is this's just quite dry aggression, Actually, not much to it. Just don't know the management of psoriasis on, So all patients are going to be on Byetta and D and logs s so that rules out. See, this is an acute exacerbation. So you gonna wanna use cortical steroid? So this is ruling out and b on you haven't tried them on AM on any medications yet. They're presenting to you. They're they're gp after the Q exacerbation. So what you're gonna wanna use is, uh, deal. Are you gonna want to use the cortical steroids once daily and then the vitamin d analog on the other aspect of the day. So one in the morning, one at night. Right. Let's move on to some more conditions. That x mark a topic X mole, a topic dermatitis. Same thing tense. Affect those who are a topic hint in the name s. So what I mean by this is people who have got there's a tryout or hay fever X mark on asthma. So associate it with in that where they're not. Try out how that present erythematous rash is with really, really intense action. Like in efficacious in. What does that mean? Basically, you get a skin change associated with chronic robin and itchin. So if you scratch an area over and over and over again, she'll get this I can if I cation on that can be seen in these two patients here. So if you have a look at the skin, which I'm kind of like highlighted here, it looks a bit more course, a bit more wrinkled. It would be it would be more, you know, because touch thicker compared to the other skin on the body. And you can also see that here with them, about that skin change some discoloration associated with it looks sort, of course, and that's one of the that. That's a common feature that you see alongside X mom. It's not because the excimer itself, it's because of the chronic itching associate. Where you going to find that in adults going to find it along the flax services? Because these the areas that rubber lot on in Children you're going to find on the extensive surfaces on along that on there on that also, because I crawl in a lot those they're gonna be the services, uh, under a lot of, you know, damaging, you know, friction, and you also going to find on Children's faces commonly run the mouse because Children dribble quite a lot more so than than the adults on D. The water in the saliva is an irritant. Water is one of the submandibular it since that are and that's where you tend to get this kind of stereotypical honestly goatee looking kind of shape in some babies who have access. Uh, how do you manage it? A millions on top, the steroids. In some more severe cases, they may use, um, UV treatments on biologics. Teo expressing your system. Uh, now, if we compare this to Publix excema this'll will affect the hands. Sometimes the feet are commonly it presents in between the fingers on dure these small kind of blisters for men these are vesicles on day, the's will burst over time and these will be incredibly, actually excellent and itchy condition as it is. Publix excimer is commonly described is even more itchy than itchy condition. It she squared. What caused by humidity? Any kind of irritants causing increased sweating. That's what you get in between the fingers with a lot of salmon. Rubbing is where you get with high temperatures. And actually there was like a boom of this of the pandemic with every motion insurance, uh, management very similar. Teo, regular x More management, more Ian's talk Steroids called Compress Sometimes I'm just not more just symptomatic relief Now moving on to explore the pet. Come on, this is a dental article emergency, so this is an important one to remember. It is where you have a patient with a topic Aximum originally. And then they get an infection caused by HSV like the typewriter. Take two on how these patients percent. Usually it's in younger patients. On day they'll be brought in by their parents saying, Oh, my child accidents gone suddenly really, really bad out of the blue. So it's kind of like an acute history. They'll be presenting the fever, possibly a bit run down before this presentation and you get this stereotypical punched out lesions. You'll see that I described in the stand, or you can see it here. So, um, you might punched out. Is these circular at them? It is. And that ulcerated. So they lost that level of the abdomen. So it's It's like, kind of like that rule appearance commonly presenting in Children. Now treatment is very important to remember because it is a dermatological emergency they should be admitted on treated with IV Acyclovir. So going up What? We just discussed SP already. So yeah, I think we will go. There's a majority here answering correctly of accident a pear to come. Just talk about the history. Acute exacerbation of axonal unwell over the past couple of days. A fever associative. And you've got these lesions on Deacon. See here it's that that punched out lesions on DPA like all straight in here is well, so let's move on to the final stretch of this talk with the final few conditions Percocet, vulgaris versus and bullous pemphigoid, um, focus for cars. This is an autoimmune condition involving the desert zones. On importantly, you get me coastal involvement. That is a really key defining factor between this condition on the next condition. What? What? Who is your gonna get these painful blisters? Because of where the disease takes place within the desmosome. You do get these. Aren't these bullous on MRI lesions forming that can be seen here, but you'll get a lot more erosions, associate it with that because rather than the disease processing happen below the opportunities and pushing up these kind of bolus lesions because within so they rupture a lot easier, more prevalent in the Ashkenazy Jewish population. That's quite important factor, remember, because that is where the majority that that is, the demographic, which will tend to find this management options systemic steroids, possibly immuno suppressants, depending on how badly the patient is presented. Now, if you compare this to bolus pemphigoid again, it's a water immune condition, but it affects the sub effects below the Dermus. So what that means is that a lot more off these bullets lesions will remain intact. Relative eso You can still get erosions that could be seen here Well, as could be seeing, you know, on this example, there's a considering more mouth off off these Bos lesions intact, and they occur around the flax of services. Is could be seeing here. Importantly, no mucosal involvement from medical school exams. In real life. Maybe, But for medical school, no more prevalent in older population is the way that I like to remember. This is It's like a pen for good old that's that's really awful. I appreciate, but you know, it works. So we move, you know, O L d. I can't spell management again or a steroids moving on to to compare these two side by side. Um, different demographics, a different amount of kind of bolus lesions versus erosions on a lot more erosions in pemphigus vulgaris. This is a lot more bolus lesions in pepper on bullous pemphigoid mucosa involvement in pemphigus vulgaris, no mucosal involvement in the other. And then it's also the differences in demographics of which these conditions are typically present. So comparing separate character sister seborrheic dermatitis, every character OSIs These are benign epidural skin lesions that they are more commonly found on the older populations on When you have a look at them, they've got this really clearly defined borders they can present in various different in different colors. Um, but all of them will have this kind of stuck on appearance with characteristic plugs of which you can kind of see here along the border. No, I don't want anyone judging me here. I read this in apartment comment section, but it did actually have this stick a bit in my mind. So I don't get judged for sharing this because this isn't how my own head works. And this isn't what I thought when I saw this. If you imagine a double chop like a double chocolate chip cookie. That's kind of like a seborrheic keratosis. You've got cookie and then you've got the Chocolate Chex. Which of the characteristic plugs? And then you stick that on a patient based mouthwash seborrheic keratosis. That might help. It's sticking in mind a bit clearer because the key difference, like the key aspects to either a description or to your own assessment. Often image will be that stuck on appearance on the characteristic chocolate chips. Management reassurance. It's completely benign. In some cases, you may want to, um, cuter, rigid or, you know, exercise it. That's purely due to, like, aesthetic reasons. But yeah, it is. It's up is completely benign seborrheic dermatitis that this is caused by overgrowth off that fungus that we previously described on dim porton me. This will affect the Sieben rich areas, So at your scalp around your nose, anywhere where there's a lot of them boils natural oils associated with pear. How would it how it looks on like a salmon e pink park kind of similar to X mama, but you may get some scaling, and also it's the region's off, which it's typically associated with in the stomach question. They met him to that over Xeloda do to like a history of dandruff or something like that. It can also present with otitis external on both, both right disk. So do you Keep your eye for that on game A ski. It's association is associated with Parkinson's commonly management first sign for the face and the body is going to be a key to cancel for the scalp. You can actually use over the counter medications and actually head and shoulders works quite well because it's got a chemical that I'm not gonna try and prevent it Sink something on. Also, you get over the counter preparations off different kind of shampoos was like Thai and which can be quite unhelpful for the for the scalp, that is so you can use the over counter preparations for scalp disease, but for the face and body, you go straight to top work you can is our second line then for the scalp is going to be using a ketoconazole topically as well. Final condition. Uh uh uh like, um plan. Uh, so unknown etiology, But I like to think of it's in my head, like in p because you can describe it with a lot of peace. So planets it is gonna be a purple lesion is gonna be paretic. So it's going to be she is going to help you lower what I mean by that is raised. And that was a large supply in dermatology. I'm not gonna let her have discussed it here because it's like it's really, really, really try. But you get, you know, different. You got your own kind of like a classification system of different Carberry, so popular is raised slightly, but not as much as a plaque on then party going on on. What I mean by that is these, like numerous angles, it's not going to be at circle. It's not going to like anything like that or symmetrical. You're going to get all these really rogue changes in shape. I'm and commonly one of the features to look out for is working. Um, stri on that's described. It's like it's a white lace, which you can get in your arm, a Cozaar, which we see quite quite well here. So just look out for those features management you're gonna wanna use topical steroids. So now that we're finished. Let's have the final few on CQ. Something that something to more and we're done. So yeah, I feel Yeah. There's considerably no agency to answering these ones than the previous ones. Yeah, all right. Just a couple more seconds. And I think we're going in the poll. Yeah, already. So this kind of three conditions, I'm through the options here. So, uh, you guys seem to kind of narrowed it down to and that's a B. Andi. So let's start with, like, implant us that's gonna present with more laced network. This looks more like a bullet lesion. Like, if you were to give you to catch it or something, a lot of puss would come out. It's not got that kind of lacework pattern asleep previously saw. So if we then narrow it down to, uh, pemphigus vulgaris versus bullous pemphigoid it is that or old mucosal involvement? That is that that kind of defining feature for medical school exams. So because that is our oral involvement, we're gonna move towards the pemphigus vulgaris. That's, um, the answer. Hey, finally, I don't see here. I'm not sure if the post work okay. Uh huh. All right. so so a few people. So that there ounces que going to throne. So, um, first of all, that's ah diagnosis condition She called purple condition with the genes which have purple. I'm popular on their polygonal because they've got many angles. That's like a pea. You can also see about that. We can destroy that. That least network which are described in the old mucosa. So then it just becomes a dry aggression of what's the management? That management is topical? Is talk of steroids on. There we are. Thank you so much. Pull, uh, listening. I really appreciate it. If you could fill out the feedback forms, but yeah, hopefully your family quite useful and become a dermatology dawns. Stop sharing a cool base. Feel free to join us on. Our psychiatry went into this Thursday. Um, before you're going to go, actually had a question. Question 12. Right. Um, start sharing. That's cool.