I have bald areas in my scalp

 

I have bald areas in my scalp Alopecia areata - Sudden onset, bald discrete areas in scalp, Follicle openings still present, Any age group. Consultation Tinea capitis - scale and broken hairs still present. Variable redness.  Consultation Trichotillomania where a person pulls out hairs in their scalp. Usually children. Funny shape and broken hairs. See this case Scarring alopecia - bald, smooth, no hair follicle openings on the surface, likely Lupus erythematosus or Lichen Planopilaris   Receding frontal hair line in menopausal female  -- Likely frontal fibrosing alopecia. Slowly receding frontal hair line with smooth hairless frontal forehead. Becoming a common disorder.   Consultation Rare - Aplasia cutis congenita, A bald area of the scalp present from birth. Sebaceous nevus     A bald area of the scalp present at birth thickening up at puberty. View the video of this topic

I am losing my hair

 

I am losing my hair Androgenetic alopecia - males and females, frontal thinning. Widening parting in females and thinning behind. Bitemporal hair line recession in males and occipital thining. Monoxidil, Finesteride ( males and post menopausal females)   Consultation Telogen effluvium - hair coming out all over the scalp but no bald areas.The small bulb on end of pulled hairs, Occurs after recent illness, operation and when certain drugs are stopped. No distinct bald areas just an overall thinning of the hair. Alopecia Areata - sudden onset of discrete areas of baldness in the scalp. No inflammation. Hair follicle openings still present in bald areas. Any age group.  Consultation View the video of this topic

My child is scratching excessively

 

My child is scratching excessively Scabies - If no past history of atopic eczema scabies is highly likely. Look in usual hot spots for burrows, web spaces, wrists, elbows. Ask if anyone else in the family is itchy. In very young babies sometimes pustules on palms and soles. Atopic eczema - Usually FH of asthma, eczema or hay fever, rash at front of elbows and behind knees, often secondary infection.  Consultations in Dermatology Papular urticaria - Sudden onset of raised itchy papules in exposed areas if fleas or covered areas if bed bugs. Exposure to pets or sand flies in sand pit. May also be a presentation of scabies. Look for burrow in the roof of the papule.  Consultations in Dermatology View the video of this topic

My child has a fever and a rash

 

My child has a fever and a rash. Sweat rash - miliaria rubra may occur with any high fever but is short lived. Viral or   Bacterial Exanthem many variants eg Scarlet fever , Rubella, Enterovirus, Hand Foot and Mouth    Erythema infectiosum (Slapped cheeks syndrome)    Measles is rare because of immunisation. Kawasaki's disease should be considered if several days of high fever with enlarged cervical nodes plus red lips and eyes.  Rare - Meningococcaemia    Consider this diagnosis if there is high fever with neck stiffness and any sign of bruising on the skin. Immediate admission to hospital for IV antibiotics is imperative. View the video of this topic

I have pigmented marks on my hands

 

I have pigmented marks on my hands Aged freckles - common in elderly, uniform colour, some can be quite dark, slow onset Lime juice rash - sudden onset, handling limes where juice on the hand interacts with sunlight giving these pigmented streaky lesions. Might be red initially. Similar from parsley and some other plants. eg figs Porphyria cutanea tarda - Unlikely to complain just of the pigmentation! Get blisters and slow healing sores in sun exposed areas particularly back of the hands.Usually excess alcohol. Sometimes with NSAIDs. Rare -Peutz Jager Syndrome - early age, pigmented freckles on lips as well, bowel polyps. View the video of this topic

Rash on my neck

 

I have a rash on my neck. Eczema - Usually chronic lichen simplex from rubbing, localised with accentuation of surface skin markings, generally on the back of the neck. Nits in scalp Pediculosis capitis - here you see excoriated eczema on the nape of the neck Poikiloderma of Civatte - mottled net like pattern on the sides of the neck with sparing in the sun protected area under the chin.Mixture of red and brown. Solar elastosis - Yellowish dots of altered collagen and elastic tissue under the skin, no scales, dots in lines Rare- Acanthosis nigricans - small dark papules arranged in lines on the posterior neck. Seen in obese people with hyperinsulinaemia. Florid cases may have an underlying malignancy. Acne Cheloidalis- mixture of pustules and keloid like scaring on the nape of the neck. Infective due to Staph. Needs long term antibiotics. View a video on this topic.

Pigmentation on the face

 I have funny pigmentation on my face.

Sun damage, Solar lentigo - Usually uniform light brown colour. If several colours or very dark consider lentigo maligna

Lentigo maligna - early melanoma, out of place darker or variably pigmented lesion on the face, smooth surface, usually elderly sun damaged

Melasma - localised uniform light brown pigmentation along the upper lip skin or on the cheeks, induced by the Contraceptive pill or pregnancy, common in younger women in their twenties.

Drug rash- Minomycin or Amiodarone - grey black rippled pigmentation on neck or forehead. Patients on Minomycin are usually on it for rosacea and have been on high doses for a long time. Amiodarone is always maximal in sun exposed areas of the face.

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My eyelids are itchy

 

My eyelids are itchy. Eczema - Atopic , often just upper eyelids, common in children, Use Hycor 1% eye oint BD to lids. Eczema Contact allergic- Usually more extensive eczema , upper and lower eyelids involved, local swelling. Consultations in Dermatology Blepharitis - Scale of the eyelid edges, slight redness, Use 1% Hycor eye oint BD and remove scale with Johnson's baby shampoo. Seborrhoeic dermatitis - not so much eyelids as eyebrow scale and blepharitis. Use Nizoral cream BD to rash. Shampoo with 2% Nizoral shampoo. View a video on this topic.

Itchy Scalp

 

I have an itchy scalp. Seborrhoeic dermatitis- Very common cause of itchy scalp. Fine scale, Often eyebrows and perinasal as well Eczema - Part of overall dry skin. Often excoriations in scalp and secondary Staph infection. Nits Pediculosis capitis) - Scratching and eczema extends to the neck posteriorly, Use Permethrin shampoo products. Psoriasis - Thick scale, surprisingly itchy at times, worsened by scratching, Koebner effect. Stress - Small perifollicular pustules repeated picked and scratched. Tycoon scalp Tinea capitis - Localised scaly scalp and hair loss with hair breaking at different levels. Rare- Diabetes - Sometimes itch is just confined to the scalp in diabetics. View the video on this topic.

Itchy rash all over

 

I have an itchy rash all over. If acute then consider a drug eruption particularly hives (urticaria). It will be red and non scaly but if red and scaly then consider atopic eczema, scabies and in the elderly a red scaly drug rash , metabolic problem (renal or liver failure) or just aged, sun damaged dry skin in the elderly. Scabies - Itch is all over but spares the face. Check the classic web spaces, wrists, elbows for burrows. If several people in the same family are all itchy it is scabies until proven otherwise. Lyclear cream or oral Ivermectin. Urticaria - Lesions come and go every few hours. Not fixed. Usually antibiotics, viral infections or food allergy for acute presentations. Autoimmune or physical urticaria if chronic. Acute drug reaction - May be urticarial or erythema multiforme or morbilliform but itch only if urticarial. Generalised and not systemically unwell. Acute flare of Atopic Eczema - Usually history of atopic eczema. May be infected. Stress a common precipitant. Chronic dry skin - Elderly with chronic already sun damaged skin. Moisturise, Soap substitutes. Rare- underlying Kidney or Liver problems, Polycythaemia vera - Renal or Liver failure leads to generalised itch and excoriations. View the video of this topic

I have a rash on my face - Red Non Scaly Painful

 I have a rash on my face - Red Non Scaly Painful

Red Non Scaly - painful - Erysipelas, Cellulitis, Early Zoster, Sunburn or Phototoxic Drug.

The red non scaly but painful facial rashes centre around cellulitis/erysipelas, Phototoxic drug reaction/sunburn and early herpes zoster. All of these can be one sided conditions.

Zoster will soon form vesicles or blisters and usually involve just one dermatome of the Trigeminal nerve.

Cellulitis and erysipelas will be tender with fever and local lymph gland enlargement and have a spreading uniform edge.There may be blistering with erysipelas.

A phototoxic drug reaction eg to doxycycline or a NSAID will usually be bilateral with no fever or lymph gland enlargement.

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I have a rash on my face Pustules

 

I have a rash on my face - Pustules Pustules Mnemonic is II Infective (viral , bacterial or fungal) or Inflamatory (Drug or Pustular psoriasis) - Acne, Rosacea, Perioral Dermatitis, Impetigo, Folliculitis, Ingrowing hairs, Tinea, Herpes simplex and zoster, Infected eczema. Facial pustules in a young person are usually part of acne vulgaris. Look for comedones.( See treatments for these conditions in the relevant module of the course.) Rosacea will be in an older person, usually female , with flushing, redness, papules and pustules. Perioral dermatitis will have small pin sized pustules among scales but be centred around the mouth with peri vermillion sparing and they will have been applying strong topical steroid cream beforehand. Impetigo will have pustules and crusts of a golden colour. Folliculitis will have larger pustules centred on hair follicles. Ingrowing hairs will be seen on the neck where the pustule is associated with the ingrowing hair. Facial tinea will show pustules at the periphery of an annular spreading area when topical steroids are withdrawn or as a boggy inflamed area of beard if a kerion variant. Herpes simplex or zoster will have grouped pustules arising recurrently in the same area of the cheek or lip. Infected eczema will usually have impetiginised crusts of staph superimposed on the weeping eczema. Common Skin Presentations 1 Additional images View this video on facial pustules

I have a rash on my face - Red Scaly Again lots of rashes occur on the face but know something about Acne, Rosacea, Seborrhoeic dermatitis, Atopic dermatitis, Contact dermatitis, Perioral dermatitis from topical steroids and solar damage here in Australia. We will look at this from different morphological points of view below. Lets look at Red Scaly (Mnemonic PMs PETAL)- Eczema, Seborrhoeic dermatitis, Tinea, Psoriasis, Discoid Lupus, Pityriasis alba, Sun Damage/ Skin Cancer A red scaly rash extending out from the scalp margin is probably psoriasis. A scaly rash confined to the eyebrows, bridge of the nose and in the nasal cheek creases is seborrhoeic dermatitis. Atopic dermatitis in children commonly involves the face and also the eyelid skin. Contact dermatitis is usually scaly and weeping and may be due to preservatives in creams or cosmetics, or something from the garden rubbed on to the face particularly plant sap. A tinea facial infection is usually scaly and annular unless a topical steroid cream has already been applied to it when the scale goes and the redness is less. Discoid lupus is a rare cause of a persistent red scaly rash on the sun exposed areas of the face and sometimes looks like multiple skin cancers. Remember that here in Queensland a lot of red scaly lesions on the face are indeed solar keratoses or skin cancers and the older the patient the more likely that is! Common Skin Presentations 1 Additional images of other conditions View this video on Common Facial Scaly Rashes

 

I have a rash on the soles of my feet. Consider Vesicular tinea - clear itchy fluid filled vesicles on a scaly base, Localised pustular psoriasis - initial pustules on instep or heel drying to brown crusts that peel away Hyperkeratotic psoriasis - thick cracked keratin on weight bearing areas of heel and edges of foot Contact dermatitis - again heels and forefoot involved if rubber or dorsum of foot if shoe glues or tanning leather allergies. Tinea pedis - dry fine scale across the foot sole and web spaces plus or minus nails Pompholyx eczema - clear itchy fluid filled vesicles often on instep. This may be vesicular tinea, an allergic reaction to tinea pedis. Use Lamasil cream . Rare- Larva Migrans - serpiginous itchy linear rash on sides or sole of foot from hookworm larvae. Tinea Nigra - dark solitary slightly scaly fungal patch on sole Pitted keratolysis - punched out holes in the keratin of the sole , heel and forefoot skin. Common Skin Presentations 1 Additional images Lots of conditions can involve the soles of the feet but the chronic ones are Tinea, Psoriasis, Eczema, Juvenile forefoot eczema in kids wearing sneakers, Pitted keratolysis with sweaty feet, localised pustular psoriasis and keratodermas. We will deal with these under different morphological headings below. View the video below on rashes on the soles of the feet

I have a rash between my toes Consider Tinea, Itchy, scaly areas between toes, May spread out on dorsum of the foot. Check toenails for fungus. Erythrasma Usually just one or two web folds, red brown scaling or white maceration Candida Similar to tinea but more macerated Gram neg infection Swelling and oozing in the toe web spaces with fish like odour, very acute onset, itchy and painful.    Consultations in Dermatology Cellulitis can spread from between the toes to the dorsum of the foot as a hot red tender spreading rash. It is a major issue in diabetics and must be rapidly referred for antibiotics, elevation and pain relief. Gout can have an apparently similar clinical presentation. Tinea would be the commonest cause. Try Lamasil cream for three weeks daily. It will deal with Candida and have some effect on the Corneybacteria of Erythrasma. Gram -ve infection is much more acute with oozing and a fishy smell.The best treatment is dilute acetic acid soaks for 10 mins BD and some Lamasil and a cortisone cream. Cellulitis requires urgent antibiotics orally.  View a video of this topic.