It’s This Rash Doc….

Richard de Ferrars

GP Programme Director

Name and one Test

Xanthelasma – check lipids

Learning Point

You MUST understand primary & secondary preventionPrimary prevention – use risk scoringBut NOT if familial dyslipidaemia, diabetes

What’s the Diagnosis & Management?

Trick questionMix of measles, Kawasaki & scarlet fever

Learning PointRash in child with fever:1) Think why is this NOT meningitis 2) Sick/ toxic – think and admit3) Eyes, mouth, lips funny - think

Name and One Test

Butterfly rash (SLE) – anti-DNA antibodies

Learning PointImmunology blood tests are complex and full of false positivesAlways do esr/ crp first and never request immunology if esr/ crp normal

Variations on a Theme

These all come from the same “cell line”

What is that cell line?

What is each a picture of?

All squamous cell – actinic (solar) keratosis, Bowen’s disease, keratoacanthoma, SCC

Learning Point:Look at old people’s hands and faces and start to form an idea of this spectrum

Eczema Creams

Arrange these creams used in eczema in ascending potencyWhich are available OTC?

*Diprobase, *Hydrocortisone, *Eumovate, Betnovate, Dermovate

Learning Point:Know what you are using. DO NOT prescribe Eumovate generically

Name and Treatment

Erythema Marginatum (Lyme Disease) - Doxycycline

Learning Point:Getting more common. Surrey is a hot-spotIf suspected – do paired serology as well as treating

Moles – The Alphabet

Four are melanomas

One is a benign mole

What does ABCD stand for?

Asymmetry, border, colour, diameter

Learning point:Look at lots, ask lotsBEWARE “let me look again in 6-8 weeks”

Name and Treatment

Pityriasis Rosea – Presumed viral, lasts 6-8w, no treatment

Learning point:Must remember as commonly brought to the GP

Name and Treatment

Pityriasis Versicolor – Fungal (malasessia furfur). Anti-fungal (orally)

Learning Point:People who chose the names (diagnosis and cause) are having a laugh….

It’s All Swollen Up…

Name the 3 conditions and your first treatment for each

Urticaria Angio-oedema Anaphylaxis

Anti-histamine Stop the ACE/ AT2 Panic?? Adrenaline?

Learning Points:AKT loves emergency drugs. Funny reaction – think drugs

Name and Treament

Molluscum contangiosum – viral & no treatment – Wart virus infection

2 different conditions

Learning Point:If you start a treatment with low success-rate for a self-limiting & harmless condition you will only be making life difficult for yourself (or other GPs)….

Four Types of Psoriasis

Name the four types shown and good first

treatment optionErythrodermicAdmit

PlaqueVit D analogue Flexural

Topical steroids

GuttatePUVA

Learning Point:Psoriasis is tricky to get rightDefinitely worth doing learning modules

Four Blisters To Finish…

Pemphigoid Shingles

Pomphlyx HFM

Learning Point:Pemphigoid is the rarest cause of blistering rash!

Learning Points

• Rash in child with fever– Think meningitis, think harder if eyes & mouth

• Look at lots of age changes AND ASK

• Look at lots of moles AND ASK

• If in doubt – ask!

The End