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INSIDE STORY - Dr Dimity WilliamsShould aspirin be recommended for CVD?Child health - Transitioning to adult care

Dermatology

Rash decisions

Rash decisions

Obese patients with diabetes often develop flexural rashes. These can be tinea or erythrasma, but often it is just intertrigo, where excess sweat is trapped between the folds of skin. These patients are particularly prone to secondary candida infection, shown in this case by the individual satellite pustules at some distance from the red axillary fold. The pustules are fragile and rupture easily leaving small erosions. This is best treated with a combination topical hydrocortisone and clotrimazole cream and a review of their diabetes control. For other images of this case, log onto www.skinconsult.com.au

Image supplied by Dr Ian McColl

Nailing the diagnosis

SOMETIMES a subungual haematoma can look like a subungual melanoma. Usually a subungual haematoma slowly grows out, but in this case the nail was unchanged after six months. There was also a suggestion of Hutchinson’s sign (pigmentation of the posterior nail fold), but careful inspection shows this pigmentation is confined to the cuticle. When the nail was removed the pigmentation left on the nail bed was confirmed as blood, not melanin. He was a golfer and continually injured his nail in poorly fitting shoes. Always be on the lookout for subungual melanoma because it is usually discovered late when ...

Image from Dr Ian McColl

A seasonal affective disorder of skin

At this time of year, patients with ichthyosis vulgaris will present for help with their dried out, fish scale-like skin. They lack a protein called filaggrin in the top layers of the skin, which impairs the barrier function. The skin loses water vapour to the surrounding dry air, then dries out and cracks.  This is an autosomal dominant condition. Treatment includes oil baths and plenty of moisturiser such as 10% urea cream. In the summer months, with increasing humidity, the problem may disappear but as the cold dry weather returns, so does the rash. For a discussion of ...

Distribution reaps diagnostic dividends
Distribution reaps diagnostic dividends

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