Acute Adult Dermatology: Diagnosis and Management: A Colour by Daniel Creamer

By Daniel Creamer

Specializes in dermatoses with a unexpected onset, quick development or with neighborhood or systemic morbidity. This name covers a variety of universal inflammatory and infective dermatoses, rarer stipulations: rashes, tumours, connective tissue affliction, travelllers' dermatoses and drug eruptions.

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INVESTIGATIONS • Lipid profile (the lipid abnormalities will reflect the type of hyperlipidaemia). • Blood glucose, liver function tests, thyroid function tests. • Skin biopsy for histopathology (an aggregate of foamy histiocytes and multinucleated giant cells in the dermis). IMMEDIATE MANAGEMENT Treat the underlying lipid disorder with dietary modification and lipid-lowering drugs. LONG-TERM MANAGEMENT ISSUES The patient must be referred to an internal physician for appropriate evaluation and assessment of other cardiovascular risk factors.

Commonly pustules in all stages of evolution are seen. Desquamation occurs as the pustules resolve (35). The eruption is both itchy and painful. DIFFERENTIAL DIAGNOSIS • Pompholyx eczema (p. 12, vesicular eczema on palmo-plantar skin). • Tinea manum/tinea pedis (p. 154, palmar or plantar erythema and scaling, usually asymmetrical). COMPLICATIONS • Erysipelas/cellulitis (rare). INVESTIGATIONS • The diagnosis is usually made clinically. • Skin swabs for microbiology (to exclude bacterial infection).

IMMEDIATE MANAGEMENT Topical therapy • General emollient therapy. • Corticosteroid ointment, twice per day (use for a restricted period): trunk and limbs: potent or superpotent. • A steroid mouthwash for oral symptoms. g. hydroxyzine 25 or 50 mg) will relieve itch and improve sleep. g. prednisolone 20–30 mg for 5 days and reduce by 5 mg each week). LONG-TERM MANAGEMENT ISSUES LP is often long-lasting, tending to resolve within 12–18 months. The papules and plaques flatten usually leaving postinflammatory hyperpigmentation which can be prominent and persistent in pigmented skin.

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