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Yeah, I can see. Um, that a few of you have already logged on. So could you just tell me if you can see my slides? And if you can just see them moving? And if you can hear me, if you're someone, just type in the chat function. Great. Okay. So we'll just wait a couple of minutes for some more people to join, and then we'll start at seven. Okay, so we'll get started. Um, so just introduce myself. So my name is Doctor Zaina Sharif. Um, and I'm currently an F three doctor working in London. Um, and today I'm going to give a talk on inflammatory dermatology. Um, so if you have any questions, um, feel free to type them in the chat, and then I'll probably respond to them at the end of the talk. Um, so today, what we're going to cover is we're going to cover. So the three main inflammatory dermatology conditions. So these are psoriasis, acne, extima, And, um, I'll also then cover some other inflammatory dermatology conditions that you might get tested, um, in your examinations Or that you might also see in clinical practice. So we're going to start off by talking about psoriasis. So to start off with an M. C. Q. So a 38 year old man presents with a sudden onset rash, he has otherwise well in himself and has no notable past medical history except a recent tonsillitis treated with an oximeter penicillin. On examination, there are multiple popular's on his trunk and proximal extremities. There is fine scale on several of these Legion's what is the most likely diagnosis. So if you just read through the options and just think about what you're most likely, answer will be in your head or write it down and then we'll go through the answer. Okay, so the answer to this question is guttate psoriasis. So looking at the question stem. So the things to, um, keep your eye out for so the if you note that he had recent tonsilitis, Um, this should give you a clue that the condition is guttate psoriasis. So typically gutted Psoriasis follows a strep throat infection or a tonsilitis by about 2 to 3 weeks. Um, and normally you'd get this kind of widespread multiple popular lesion on the back, Um, and the fact that in the question it says there's fine scale on several of these lesions. Also points towards psoriasis because typically in psoriasis, you'd get a scale with your lesions as well. So another MCQ So a 50 year old has recent surgery for fixation of a wrist fracture, he develops a red scaly lesion at the site of the wound. What is the most likely explanation of this event? So if you just read through the options and once again if you just think about what you're most likely, answer will be okay, so hopefully we'll have to think, um, so the answer this question is the koebner phenomenon phenomenon. So this patient basically has developed a psoriatic plaque, um, at a site of surgery that he's had on his wrist. So the Koebner phenomenon basically describes, um, the phenomenon when you have skin drama and you developed this psoriatic plaques at the site of any skin trauma. So that might be surgery. It might just be a cut or abrasion, or it might even be a blood test if you have a needle, um, to the skin that creates skin trauma and you can develop a psoriatic plaque at this site. So the covid a phenomenon is something to be aware of when thinking about psoriasis. Um, so just to talk about psoriasis and further detail now, so the most common sights of psoriasis on the scalp, the elbows and the knees, Um, and typically it's a lifelong condition, but it fluctuates an extent and severity, and you typically have two peaks, so early adulthood. So it's kind of 15 to 25 years of age and also in your fifties and sixties. So when you're diagnosing psoriasis, it's typically a clinical diagnosis. So you you can just see how the rash presents in itself. It's quite a classic. Um, the way it looks is quite characteristic. Um, and normally you would have a family history. So making sure that you ask about family history, um, on history taking is important. Um, you can take a biopsy of psoriasis, but typically it is a clinical diagnosis. But if you were to biopsy, this histology would show epidermal hyper proliferation and inflammatory infiltrate. So I'm just gonna go through some images of the different types of psoriasis now, just so that you can. This can help you kind of recognize different presentations of psoriasis in clinical practice. So this is your typical chronic plaque. Psoriasis. So this is kind of your most common, um, And you can see the scaly, red, well demarcated plaques, and you can see that kind of silvery scales overlying the lesion's as well. Um, and typically, um, psoriasis mainly affects the extensive services. So you can see it on the kind of extensive aspects of the knees just in the picture to the right there and so got it. Psoriasis. So this is what, um the MCQ is about and what we've spoken about already. Um, so typically, got it. Psoriasis, fellows, a strep throat infection by about 2 to 3 weeks. Um, it can be your first presentation of psoriasis. Um, and it's most commonly seen on the trunk. Um, and you'll see kind of multiple multiple pap yours as well. Um, and typically, this condition can occur in Children. It can occur in young adults as well. So this is psoriasis of your scalp. So sometimes this can be kind of the only presentation of psoriasis, and it can be your first presentation. Um, so you'll see the kind of silvery scale within the scalp. Um, here as well, so it's important when you're examining a patient just to make sure you examine their scalp as well. Um, and this is another type of psoriasis. So Palmer, plantar psoriasis. So this typically affects the kind of source of your feet or the palms of your hands. Um, and you can see that you've got kind of fish oring, um, of the skin and you can see that you've got keratoderma, which is thickening of the palms and the soles. This is another type of psoriasis, so it's called Flexeril or inverse psoriasis. So, as I mentioned earlier, psoriasis typically affects the kind of extensive aspects. Um, but if you can sometimes get it kind of under the arms or in kind of groin fold as well. And typically if you see it in these areas, it doesn't look like a classic psoriasis. So you don't actually get the scale that you would normally see in psoriasis? Um, you would just get kind of red shiny patch instead, so you can see it under the arm and the left, and you can see it just in the groin. Fold on the right. Okay, so this is a referral dynamic psoriasis. So this is, um, the probably the most important one to be aware of because it's kind of a medical emergency. Um, so typically, um, erythroderma means kind of covering more than 90% of the body surface area. Um, and it's important to get kind of urgent medical attention. If you see a patient like this because it can have issues with temperature disregulation, it can result in electrolyte imbalance. It can result in a patient losing lots of fluid and electrolytes from their skin because the skin barrier is impaired. Um, and it can lead to high output cardiac failure because you're losing a lot of fluid as well. Um, so also another area to examine is your nails so you can get nail psoriasis. So typical features of nail psoriasis are pitting, which is probably the most classic one. So in the image to the left, you can see the little kind of indent Asians, um, within the fingernail. Um, so this would be pitting. And then you can also get a nickel isis as well seen in the picture on the right, which is when the nail detaches from the nail bed. Okay, so just going into kind of factors that will trigger or exacerbate psoriasis. Um, so as we said, it's kind of a chronic condition, but you can have occasional flare ups of psoriasis, so things like strep throat, as we mentioned, can trigger gutted psoriasis. Other infections as well can trigger psoriasis, especially HIV. Um, we mentioned the koebner phenomenon, so any skin trauma cuts, abrasions, even sunburn, um, or needles or anything like that can cause a flare up at the site of skin trauma and other factors risk kind of triggers to be aware of are things like obesity, smoking, excess alcohol, stress and also certain drugs. So lithium antimalarials like chloroquine, um, and beta blockers can also trigger psoriasis. Um, also, withdrawal of oral steroids or strong topical steroids can also, um, cause a flare up of psoriasis. So that's why even though psoriasis can be treated with topical steroids, it's really important that when a patient is coming off the topical steroids, you wean them down gradually. Okay, so moving on to systemic aspects of psoriasis so you might have heard of psoriatic arthritis so psoriatic arthritis can occur in up to 30% of patient's um so typically psoriasis. The skin manifestation precedes the psoriatic arthritis, but it in cases you can get the arthritis before you get any skin manifestation of psoriasis as well. Um, the other thing you can get with so psoriasis is associated with inflammatory bowel disease, and it's also associated with kind of inflammation of the eyes, like give the itis as well. Um, and typically in exam questions, you might ask kind of what causes early mortality of patient's in Smith psoriasis. And it would basically be due to an increase psoriasis, causing increased cardiovascular risk. So, um, psoriasis is often associated with the metabolic syndrome. Um, so hypertension, obesity, type two diabetes. And this can all increase your cardiovascular risk of things like having a heart attack like M. I or peripheral vascular disease. So just thinking about management of psoriasis now. So I just created a flow chart just to kind of break it down. Um, so, normally, as with any other skin condition, you would always start with your topical agents so you can start with emollients and these basically you apply to the skin and especially style. Acetic acid for psoriasis will help to remove any kind of silvery scale. Um, you can also put on some topical corticosteroids, and this will reduce the redness and all the inflammation and reduce the thickness of the plaque. The other thing you can use is vitamin D analog. These and these inhibit epidermal hyper proliferation, so you would start with those. You would avoid your perceptions, like any drug causes or kind of smoking or excess alcohol. And then, if those don't work, you would move onto Phototherapy. So there are two types of phototherapy, so you can have UVB phototherapy. But the main one used in psoriasis is something called Puy Va, which some of you might have heard of. Soap You've A is basically when you're given an oral pro drug pro drug called Sorlin. So basically, patient's ingest this pro drug, and then they are exposed to UV A Um, and then this uva basically activates the pro drug that they have ingested, and it helps to treat the psoriasis. So normally patient's who have just received Hoover in kind of a dermatology clinic. They'll you'll see them kind of leaving the building wearing sunglasses. And this is because if they've had this pro drug and then they're out in the outside world exposed to all the UV radiation. Um, this can lead to cataracts, so they often wear sunglasses, Post private therapy. Um, so moving on after phototherapy if if they're still hasn't been any improvement in their skin, they then move on to systemic agents. So things like methotrexate, cyclosporine or retinoids, especially acitretin in psoriasis. So obviously, with systemic agents, there are lots more side effects. Um, compared to the topical agents. So methotrexate is typically a drug given once a week, but it can cause side effects like liver fibrosis, bone marrow suppression and importantly, it can be teratogenic. So manufacturers kind of advised to avoid conception for about six months after stopping methotrexate. Um, so it does have kind of long term consequences as well, and it requires lots of monitoring the blood test as well. Whilst you're on the therapy as well. Um, also a citrate in. So this is also teratogenic, so women should not conceive for three years after, um, stopping a Stratton. So again, this has long term consequences. Um, moving on from other from systemic agents. You can then also consider biologics, which would be your kind of final line therapy. So these are kind of TNF alpha inhibitors things like infliximab or return. Except Okay, so now I'm moving on to acne. So to start off with an M. C. Q. Um, so a 15 year old gentleman presents his GP complaining of a bumpy rash on his face, which is painful and interferes with shaving. On examination. There is widespread erythema and postures. What would the first line treatment be? So I just have to let you have a think about your answer. Okay, so the answer to this question is topical benzoyl peroxide. So these questions then basically points towards acne and the things you should look out for the kind of bumpy rash on his face. So that kind of describes pap yours and we It also says on the question that there are widespread postures as well. So this is a popular postular acne. So in terms of treating acne, so we'll discuss this in a few slides. Um, but you have your, um you you always start kind of treating with your topicals. But if the acne is predominantly popular postular you would treat with topical benzoyl peroxide. First line So that's why this would be your answer in this question. If the questions then pointed towards more kind of calm Adonal acne. So a predominance of comma Don's as opposed to pastures. Your answer would be a topical retinoid, but we'll discuss that in a few slides time as well, just to go over the management of acne in more detail. OK, so just to start from the beginning. So what causes acne? So acne is disease of the hair follicle and the sebaceous gland. So normally you can see an image A. You've got your normal hair follicle. And what happens in acne is you have abnormal characterization of the follicular epithelium. So normally encouraging ization you have, um your keratinocyte will die and they will separate from each other. But when this process is abnormal, what happens is these cells will stick together and these will form a follicular plug, which so the cells plus the sebum will create a follicular plug and that will cause blockage of the hair follicle. You'll So this, um, this blockage will then distend the hair follicle forming comedones so you can see an image be you've got the kind of distended hair, folic. You'll, um And you've got this white head comedonin. So a white head is a closed comma dome, so this basically means that it's trapped underneath the skin. So typically in kind of in a patient, you would see what you'd see on their skin. Is these kind of little grains of rice trapped under the skin? And this would be termed a white head. Um, you then, um, can develop open comedones. So this is a blackhead. So typically what occurs? The blackhead is the opening into the skin is a bit dilated, and you get the dead kind of skin cells and sebum collecting at the top of the dilated opening, forming this little blackhead. Um Then what happens is this this, um, follicular plug causing the distention of the hair molecule will burst and rupture into the surrounding skin. And this will create an inflammatory process releasing inflammatory mediators into the skin. And this will result in papule is postural insists. So basically, um, whether you get papeles postural or cysts will basically depend on the extent of the inflammatory process. So that's so you have you're kind of starting point, which is your non inflammatory process, which is, um, which is number one and then your, um, inflammatory process occurs is in stage two. So the other factors that contribute to, um the development of acne are increased sebum, excretion and also a bacteria called pro peony, A bacterium acnes, which is basically on your skin already. Um, so these both contribute, um, androgens also increased sebum production. So this is why in puberty, when you have excess androgens, you basically get lots of acne in teenagers and also in conditions like polycystic ovaries. Whether excess androgens, you can also get increase in sebum production and therefore consequentially, you can also get acne. Um, so your typical distribution of acne is on your face, chest and upper back, and this basically mirrors the sebaceous gland distribution. So basically the areas where there's more sebum. Okay, so just thinking about the different types of lesions within acne. So these are the type of lesions you'll see on someone's skin. So as we mentioned before, you've got your noninflammatory lesion's. So you've got your black heads and you got your white heads, and then you've got your inflammatory lesion's So you've got your pap fuels your posture ALS, your cystic lesions and your nodule. So it's important to familiarize yourself with these types of lesion's just so that you can recognize what they look like on someone's skin. And then you can determine what type of acne you're dealing with. So just thinking about what can trigger acne and what can cause it to flare up so things like, um, endogenous or exogenous androgens? Because, as we said earlier, androgens can increase your sebum production, resulting in acne. Um, certain drugs, such as steroids can increase in can cause an increase in acne, um, other things like environmental humidity or if you apply cosmetics, Um, or sometimes things in your diet, like dairy and high glycemic foods, can also contribute to acne. But there's ongoing debate about the role of diet in acne. Okay, so these are your types of acne, So we I showed you pictures of the different types of lesion's before, Um, so you've got your com Adonal acne. So in this picture, you can see lots of little blackheads. Um, and those are the predominant lesion's in this photo. So that's why you'd call it a calm Adonal acne. Um, then In the second picture, you can see a predominance of popular's and postures, um, over comedonin. So this is this is why this would be termed popular postular acne. So even in this type of acne, you would still see comedones. But the predominant lesion you would see would be popular and postures, which is why we call it popular postular acne. Then you move on to your most severe type of acne, which is your nodulocystic acne. So you can see these kind of deep, kinda painful looking lesion's. And that would be your most of it. And typically this is the type that can lead to scarring as well. And if you are, uh, a GP in primary care, if a patient comes in G with nodulocystic acne, you would want to basically immediately refer them to a dermatologist because most of the primary care treatments won't be kind of good enough to treat the nodulocystic acne. Okay, you might have also, um, seen mask me, um, kind of everywhere during the covid pandemic. So this is a type of acne called mechanical acne. Um, and this typically occurs because of irritation, um, to the skin, with certain materials, overlying it so some. Sometimes you can get it with masks or you can even get it. Think about wearing a helmet and you've got a chin strap. Um, sometimes people develop kind of acne where the chin strap is Just use irritation of, um, the chinstrap on the on on their skin. Okay, so just thinking about acne management again. So just created another flow chart just to create it, kind of just to make it easier to see the stepwise process. Um, so you always start with your topicals. So if it's calm Adonal acne, you would start with topical retinoids. So I said, try to know in the coma Donal acne. And then you would use benzoyl peroxide, the postular acne. Um, and you can use other topicals such as azelaic acid or topical antibiotics. If your topicals wouldn't work, then you're still having kind of significant acne. You can then trial some oral antibiotics. Um, so these need to be trials for at least two months. Um, in order to say that they have kind of some effect. Um, these can be prescribed by your G p. So typically, oral tetracycline's a first line. Um and second line would be a rhythm, Eisen. So this can be used if you're intolerant to tetracyclines or if you're pregnant. Now, a common exam question is that if you have acne and you suddenly develop and you start on some kind of oral tetracyclines, um, and then you suddenly have worsening acne. Um, the cause of this worsening acne acne might be due to a gram. Negative folliculitis basically induced by the antibiotics. So in a case like this, the main thing to do would be to stop the antibiotics. Okay, so following your kind of two month trial of antibiotics, if you're still not getting anywhere, you need to be referred to a dermatologist who they might then start you on a systemic retinoid called IC tretinoin. So this is, um, a systemic agent, which can reduce even exclusion. Um, but it needs to be kind of closely monitored. You need to have blood tests before starting it. And also you need to have a pregnancy test because it's teratogenic as well. So whilst you're on it, you need to be on two methods of contraception, and you need to wait for five weeks to conceive one stopping as well. Another common exam question is kind of what the most common side effect of I stress known is, um, So the main side effect is that it can cause dry eyes, dry skin, and it can cause nosebleeds as well. Okay, so moving on to our third main inflammatory condition, eczema. Okay, so they're so dermatitis and eczema, so they they basically mean the same thing so they can be there. The times that can be used interchangeably. Um, So, um, there are three kind of types of dermatitis, So number one, you have your contact allergic dermatitis. So this is when you get dermatitis triggered by a specific allergen. So this is a type for hypersensitivity reaction. So a delayed hypersensitivity reaction, and normally, you get prior sensitization to an anti gin. Um So, for example, a nickel ring. And then when you are subsequently exposed to that, um, antigen on the skin, you will then develop a delay dermatitis after 2040 96 hours. Um, so, for example, in the diagram on the right, you can see that someone was clearly wearing a ring, so this might have been a nickel ring, for example, So the first time they had this nickel ring on, they might not develop any reaction and then subsequent exposure to this because they had prior sensitization, they would then develop a dermatitis on the skin 24 to 96 hours after this. Um, so in order to diagnose kind of what causes this dermatitis so you can do patch testing. So, um, normally this works by a chemical is being applied to the skin for about 24 hours, and then you can recheck the skin in 48 to 96 hours to see if a dermatitis type reaction has developed to any of the chemicals applied. And this can tell you what the allergen is and what you can avoid on your skin. Um, so that's contact allergic dermatitis now moving on to contact irritant dermatitis. So this is, for example, when you're using lots of alcohol gel on your skin. This can cause damage to the skin barrier, and what happens is once this skin barrier is damaged, all the substances can infiltrate and damage the deeper layers of your skin, creating an inflammatory response So this type of dermatitis doesn't create, doesn't require any prior sensitization, so you'll get an inflammatory response to the skin the first time you're exposed to the substance, Um, and repeated infrequent exposure to. For example, alcohol gel can lead to more inflammation of the skin, um, and worsening dermatitis because there's kind of progressive damage to the skin barrier. Okay, and then your third type of eczema is a topic dermatitis. So this is the one that's probably most classically referred to as Isma. And usually you have a personal or family history of ATP, and Patient's will typically also have an inherited skin barrier abnormality. So this is your atopic dermatitis, so I'm just going to speak about this in more detail. Um, so the main thing to note about eczema is that it's itchy. So if there's no itch, then the rash is an eczema. So typically it's associated with a T. P. So things like hay fever, asthma, food allergies, um, or it can be associated with a family history of ATP. So, um, anyone in the family who has these things as well so 80% of cases occur in Children less than six years old. Um, it's typically a clinical diagnosis, so it has quite, um, you know, you can just identify it just from what? From what you clinically and visualize. Um, it typically affects the kind of flexible services as well as you can see it behind the knees in the image below. Um, and it's a chronic dermatitis. Um, but you can get acute flare ups of the condition. So in the chronic dermatitis, the in the image above, you can see kind of like unification, um, and skin fishery. So, like, unification is basically just when you have thickening of the skin is thickening of the epidermis. Um, just as the cells are regenerating and then you can get acute flares of eczema, so this will be kind of very red. You might have a weeping skin as well. It'll be quite wet. These are other types of eczema that you might encounter in clinical practice as well. Um, so in the image on the left, you can see these little little vesicles on the palm of the hand. So this is referred to as pompholyx eczema. So normally, it affects kind of the palms of the hands, and you can see it between the fingers as well. Um, And there is for personal or family history of atopic eczema in 50% of patient's, um, and typically it's related to sweating or humid conditions. So if you get an exam question that mentions kind of sweaty conditions or anything like that and then development of the schools on the hands think of pompholyx a eczema, Um, and then on the right, you can see your discoid nummular experts. So this is another type of eczema, and it's just well defined, coin shaped plaques of eczema. Okay, so thinking about the management of eczema now. So, um, as before, you start with your topical agents, so your emergence. So you want kind of ointments already ointments to help with the dry skin that you get with eczema. And you can also give topical antiseptics as well, um, to prevent any kind of secondary infection. Um, and sometimes sedative anti histamines are given. Um, and it's not because of the antihistamine effect is actually more due to the due to the sedation. So, um, sometimes when Children have the eczema, they're kind of up all night itching. Um, and that can create worsening of the eczema if they keep scratching it so by giving them a sedative antihistamine. This basically helps them sleep at night and prevents them itching their skin. So, actually, non sedative anti histamines would have no, um, effect on treating eczema. It's only the sedative anti histamines that would work in this case. Um, so then you would use your topical corticosteroids So normally, um, with steroids, you have a kind of steroid ladder. So you have your low potency steroids, which are your weaker steroids like hydrocortisone. And then this goes all the way out to your kind of stronger steroids, like, um, things like, damn of eight. Um, So normally, if you kind of just want to maintain your eczema and you want to prevent any flare ups of eczema, you can use a low dose topical corticosteroids like hydrocortisone. Um, And if you get an acute flare of eczema and it's really bad, you can use a high dose. You can use a high potency steroid, um, cortical steroid cream like, um, something like damn bait. Just for a few days just to tackle that acute flare. Um, also, you can use steroid sparing agent. So, for example, on the face and the eyelids. Um, you can use things like tacrolimus. So this is a calcium urine inhibitor. Um, and the benefit of this is that with steroids, if you use them on delicate areas like the face in the eyelids, it can cause thinning of the skin. So that's why um, in cases like this, things like tacrolimus our preferred, um, and then moving on. You can if you use all these topical agents and the X is still very bad. Um, you can think about things like prednisolone is the thigh Brynn's like the sporin and methotrexate. So all your systemic agents. Okay, so just another MCQ for you. Um, so a 27 year old female patient presents with an itchy red rash around her mouth. She has no personal or family history of skin conditions. Only past medical history is asthma. What is the most likely diagnosed as Okay, Okay. So hopefully you've had time to think about your answer. Okay, so the answer to this question is perioral dermatitis. So the thing to note in this question stem is that her past medical history is asthma. So perioral dermatitis is a condition that is basically precipitated by either topical steroids or also, um, precipitated by inhaled cortical steroids as well. So, for example, if you use inhaled steroids of your asthma, this can lead to perioral dermatitis. So that's the main clear in this condition. Also, the fact that it's it's you suggest a dermatitis. Okay, so another MCQ So, um other comes to see with her three year old son, who suffers from eczema. She reports that his eczema has become a lot worse this week. In addition to this, he is not acting like his usual self eating and drinking less than usual and not playing with his favorite toys. What is the most appropriate management? Okay, so moving on to the answer. So the answer here is IV a psych Lipper. So this is a classic case of eczema hepatic. Um, so this is a medical emergency. So eczema herpeticum is basically when you have eczema and you have herpes simplex virus. On top of that, um, you can develop as you can see in the picture. Um, you can see this this kind of vesicular type lesion's on the skin. So it's really important to make sure that the patient the child go straight to a and E in this case and that they get immediate treatment with IV acyclovir. So that's a really important one to recognize, um, in clinical practice. So now that we've covered the kind of main three inflammatory conditions, I just wanted to cover a few more common skin conditions. Um, that you might also get asked in exams or that you might see quite commonly in clinical practice. So another MCQ, a 43 year old woman, comes for a review. A few months ago, she developed redness around her nose and cheeks. This is worse. After drinking alcohol, what would be the first line treatment? Okay, so hopefully you thought about your answer. Okay, so the answer to this question is topical metronidazole. So the way to approach this question is, First of all, you kind of need to make a diagnosis and then decide on how you're going to manage it. So the diagnosis in this case is rosacea. Um, and the first line management for rosacea is topical metronidazole. So going into rosacea in a bit more detail. So it's a chronic inflammatory skin condition typically occurring between the ages of 30 and 60 years. um you get classic erythema telangiectasia flushing of the skin, a Deemer of the facial skin, and you can get popular's and postures, and you can also get rhinophyma, which is basically when you get thickening of the nose and you can get all these kind of bubbles forming on the nose as well. So you can see that in the image just at the bottom there, if you look at the patient's nose. And what kind of distinguished what differentiate is this from acne? Is that you don't get comedones in rosacea, Um, in rosacea. It's important to be aware that you can get ocular involvement so you can get bluff rightists, keratitis, klor itis and uveitis as well. Um, and typical management of rosacea. So, as mentioned, your first line would be your topical antibiotics. So topical metronidazole. And then you can also use kind of other topicals things like azelaic acid or ivermectin. Um, and then failing this, you would move on to your systemic antibiotics like Tetracycline's or metronidazole. Um, now, with those Asia, there is also a treatment called brimonidine. Um, so this is actually a treatment mainly used to improve aesthetic appearance in rise Asia. So patient's with rose. Asia will typically get quite a lot of erythema and flushing of the skin. So you say a patient with those Asia had an event that they wanted to make sure that they're kind of face wasn't flushed for they could take brimonidine. Um, they could use this. And this basically helps to constrict the vessels, um, in the skin, reducing the appearance of erythema. Um, and then in terms of the rhinophyma um, so the only way to treat this is with surgical dermabrasion. And the important thing with these Asia is that you should never treat with topical cortico steroids because this can make, uh, MRIs Asian much worse. Um, and typical kind of triggers arise Asia. So things like drinking alcohol. So as mentioned in the question stem in the previous MCQ. So it mentioned that she's been drinking alcohol so alcohol can trigger it. Things like hot and spicy foods can trigger it. Um, and also kind of UV light as well. Okay, so moving on to another condition. So acne inversa, also known as hydrogen itis, super achiever. Um, so this is when you get inflammation of the, um a big green sweat glands. Um, and you can get abscesses pass and scarring in the eggs Illy, the groins and the perineum. Um, so you can see what it looks like in the images so you can see these lists all kind of populous, un deep in underneath the skin, and you can see the scarring, um, that it causes as well, and it's typically kind of under arms or in the groin region. So this condition often starts in puberty. It's most active, and it's in kind of the ages between 22 forties, and it's also more common in females as well. So the risk factors for this so patient's might have a family history of it. Things like smoking, obesity, insulin resistance and African ethnicity can also increase your risk of having this condition. Um, so the diagnosis is clinical, so just looking at kind of the recurrence of the lesions in the same place kind of under arms or in the groin would normally point towards this as a diagnosis. Um, and your management, we're typically involved. Antiseptic chlorhexidine wash is to prevent any secondary infection, and you'd also typically have quite a long course of antibiotics. So normally this is with treated with tetracycline for about three months. Okay, so another important condition to be aware of is urticaria and angioedema. So, typically, when you have when you're exposed to kind of any allergen or anything like that, your mar cells and basophils will release chemical mediators such as histamine, which can create an Earth carrier so you can see the wheels, which are the lesion's depicted in the image above. Um, so you can see these kind of red characteristic lesion's, um, and that signifies rash carrier. Um, also, if you have the chemical mediator Bradykinin released, this can lead to angioedema, which is depicted in the image below. And this is basically just localized swelling, mainly of the eyes, the lips, the genitals or the upper airway. Now the main thing to note in Earth Carrier is that the way to diagnose to to diagnose Earth carrier is that the individual wheels. So these individual red lesion's must last less than 24 hours. So even if kind of the rash as a hole in the body last more than 24 hours, when you look at one specific red wheel, it should last less than 24 hours. And that's how you diagnose Askariya. So that's quite an important point to be aware of. Um, so your diagnosis Vegetarians clinical, Um, and you can also use kind of skin protesting position allergens like drugs and food allergies as well, just to avoid these in future. Um, and your management would be with antihistamines. So acute at carrier is when your whole Earth Carol episode last less than six weeks. Um, and the causes can be a recent infection. Um, it can be caused by a food allergy drug allergy or a bee or a wasp sting. And again, skin protesting is quite good to identify what the allergen is so that you can avoid this in future. And you can just see, um, this is a Q as carry depicted in, um, uh, skin and a patient with skin of color as well. So you can see you can't see the erythema as much, but you can definitely see the kind of raised outline of the lesion of the wheel. Okay, so now I'm even onto chronic urticaria. So this is when the whole Earth Carol episodes last more than six weeks So you have two types of chronic Earth carrier. So you have your number one, your chronic, spontaneous earth carrier. And this is, um, an unknown cause, but it's typically associated with chronic autoimmune disease. So things like celiac, thyroid disease or Lupus and you also have your chronic inducible earth carriers. So this is when the earth carrier is induced by a noon trigger. So you're just going into the chronic inducible earth carries in more detail. So many of you might be familiar with demographic Zim. So this is when you kind of scratch your skin and you develop these urticaria lesion's around the areas that you scratched so you can see an image, um, at the top of your screen, which depicts demographics. Um, so you can see that the patient has scratched and this has created, um, these wheels, um, you can get a delayed pressure at a carrier. So, for example, if you're carrying kind of heavy shopping bags with your hands, um, you might then develop a type of urticaria kind of a day after on your hands where you were carrying your shopping. Um, and this would be due to delayed pressure at a carrier. Um, you can also develop a solar edge carrier. So this is when you're exposed to the sun and you can get a carrier in wherever you're kind of experience in the sun, Um, and then you can get a cold as carrier. So, for example, um, if you can see in the image below, you can see that someone's put some ice on their skin. And in this in this area, you can see a wheel has formed due to the ice on the skin. So that's a cold urticaria. And sometimes you can get patient's collapsing in cold water because of Cold Earth carrier, so it can have quite significant consequences. Um, you've also got you can have a common adjective urge carrier, which is when sweat induced by exercise. Emotional stress can lead to, um as carrier. And you can also get an academic US carrier, which is when water of any temperature on the skin can create these wheels as well. So these are just kind of different types of scary to familiarize yourself with, okay, so moving on to angioedema so angioedema can have multiple different causes. So number one it can be due to an allergic drug reaction or a food reaction, and normally it would occur alongside Earth carrier. And it would be kind of a couple of hours after exposure to the allergen. Um, secondly, you can have a non allergic angio edema. So an ace inhibitor induced angioedema is something to be aware of. Um, so normally, this occurs days two months after an ace inhibitor is taken. Um, and the way to distinguish this from an allergic earth carrier is that you wouldn't it from an allergic angioedema is that there would be no urticaria with an ace inhibitor induced angioedema. Um, your third type of angioedema would be hereditary angioedema. So this is a rare autosomal dominant condition, and it's due to a C one esterase inhibitor deficiency. And typically, um, you might have a family history of sudden death because because of, um, family members having sudden airway obstruction due to this condition, Um, and equally there would be no Earth carrier in this condition. And the way to manage hereditary angioedema is basically to give patient's the C one esterase inhibitor, which they are deficient in, and you can see in the picture of the kind of eyelid swelling. Um, which kind of depicts angioedema? Okay, so moving onto folliculitis. Um, so this is when your hair follicle becomes inflamed. So this is when you get kind of tender red spot where the pastoral centered on the hair follicle so you can see in the pictures you've got the hair follicles and you can see this little red lesion with past, um forming around the hair follicle so it can occur in any area where you have hair growth. Um, and it can be caused by multiple different things. So infection, typically staph aureus infection. Um it can also be caused by occlusion. So if you wear tight genes that can cause kind of friction and occlusion, which can precipitate folliculitis, um, and also irritation by shaving can also lead to folliculitis as well, and things like excess sweating. Um, and obesity can also make this condition more likely. So, in terms of diagnosis of like colitis, it's mainly a clinical diagnosis. Um, but you can always if you can see past coming from the lesion's, you can always take a, um, a swab for culture just to see if there is any staph aureus grown. And if there is, you can treat it with some either topical antibiotics or or an antibiotics. And usually you'd want to use topical antiseptics, um, on it as well. Um, another kind of common exam question is, um, say a patient kind of just comes out a hot tub, and they noticed this red rash. Um, you This would typically be a hot tub folliculitis, and it's caused by a pseudomonas infection. Okay, so a spot diagnosis for you. Um, so a 34 year old man presents with an itchy rash on his genitals and palms. He has also noticed the rash around the site of a recent scar on his forearm. So you just think of what inflammatory condition this might, um, represent? Okay, so this was like in planus. Um, so this is a chronic inflammatory skin condition, and the way I remember it is so plainest soapy. For planus, it's purple. It's paretic polygonal plaque, and it's popular. So those the key features of like, um planus. So it's quite an easy way to remember. Um, typically, you can also see what's called Wickham's trio. So if you look at, um, the images just of the mouth. Um, you can see this kind of white lace like pattern in the oral mucosa, and some say, describe it as kind of Chinese calligraphy looking And And this is quite common if, like, um, planus, um and so as kind of shown like complainers can affect the oral mucosa. It can also affect the genitals, um, as well as the skin. And it can also cause scarring alopecia as well. And you can have, um, it can affect the nails. So the diagnosis is typically clinical, but you can't take a biopsy of it to confirm your diagnosis. Um, and management would be with potent topical corticosteroids. And if this doesn't control it, you can then move on to your systemic, um, oral steroids. Um, one thing also to be aware of with, like, complain is is that if you get chronic, like complaining of the mucosa, um, you can get oral squamous cell carcinoma, so that's something to be aware of. This is the final condition that we're going to talk about. So this is like in sclerosis. Um, so this is another chronic inflammatory skin condition, um, so it can affect the skin and it can affect the genital mucosa, and typically you get a trophic wrinkled skin, and the whiteness of this condition is quite striking, so you can see in the pictures that it's very white, especially in the picture. At the bottom, you can see the skin looks quite wrinkled, and you can sometimes get kind of blistering and bleeding from the atrophy of the skin as well. So this can sometimes be seen in the genitals of Children. And if it is seen in the genitals of Children, it's often misdiagnosed as a nonaccidental injury. Um, so it's something it's kind of an so that's an important kind of differential to be aware of. Um, if you do have chronic lichen sclerosis of the genitals, this also increases your risk of squamous cell carcinoma. So this is another thing that needs to be closely monitored and management. Um, as with lichen, planus would be with potent topical steroids. Okay, so that's the talk complete, So thank you very much for watching and listening. Um, if you have any questions, if you want to type them in the chat and I can try and answer as many as possible. Um and Also, if you could just scan the QR code on your phone, it will take you to a feedback form. Um, and if you could complete that, we'd be very grateful. And you'll get a certificate of attendance once this is complete as well. So I'll just let me scan that for now. Um, and I'll just quickly go to the chat just to see if any questions have been asked. Okay, Okay. So if anyone has any questions, just feel free to type them in now. Okay. All right. So, um, hopefully feedback forms should have been sent. Um, but I'll leave this on the screen. I'm just a scan. The QR code, And then you can fill in your feedback form, then, um, I didn't see any questions on the chat, but obviously, if there are any questions that you guys want to ask the future, feel free to contact. Mind the bleep. Um, thank you for listening. And I hope you found that talk useful. Okay. Okay. I was going to put the link to the feedback in the chart as well. Okay, so I just put the feedback link in the chart, So if you can just click on that and that, and that would be great. So just saying that someone's asked at all types of psoriasis equally genetically predisposed. Um, so with gutted psoriasis that's triggered by a strep infection so that one would be less likely to be genetically predisposed in terms of all the other ones than there is a genetic predisposition. Yes. Mhm. Yeah. Um, so for those asking you about a copy of the slides so a recording of the event will be put on online the bleep so you can access it that way. Uh, yeah. Uh huh.