Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit http://skinhelpdesk.com


Acne Keloidalis Nuchae

A nice case of AKN I saw today. Some consider this a condition similar to pseudofolliculitis in people with keloidal tendancy. The recent findings of Sperling et al indicate that AK is a primary form of scarring alopecia. I have started him on topical isotretinoin and doxycycline. I have called him for intra lesional triamcinolone next week.
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Facial Wart

Facial warts are recalcitrant in many cases despite multiple therapeutic efforts. I have noticed an association with pseudofolliculitis barbae in many of my patients.

Choices to treat facial warts should be cautious, in consideration of adverse cosmetic consequences. On application of DPCP to the warts of the face, inflammation may set in before resolution. Mild discomfort, burning, irritation and erythema were quite common but the incidence of major side-effects was very low.

Studies have reported benefit from tricyclic antidepressants, guanethidine, and trospium chloride (an anti-cholinergic quaternary amine used in Europe for urinary urgency). Hypnotic suggestions may work on facial warts before warts from the rest of the body.

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Pyogenic Granuloma

The different types of Pyogenic Granuloma are:

Disseminated
Subcutaneous
Intravenous
Pregnancy associated
Drug Induced. (retinoid & protease inhibitor)
Mucosal

Pyogenic granuloma before and after electrocautery.

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SAHA Syndrome

Today I will post some details about SAHA syndrome which I feel is relatively common here.
Seborrhoea, acne, hirsutism and alopecia or SAHA syndrome predominantly occurs in young and middle-aged women. In addition to its association with polycystic ovaries, the condition can also be associated with infertility, cystic mastitis and obesity.

Four types are described
(1) idiopathic,
(2) ovarian,
(3) adrenal, and
(4) hyperprolactinemic SAHA.
The HAIRAN syndrome has been currently described as a fifth variant with polyendocrinopathy.

The patient needs a hormonal screen (testosterone [free and total], DHEAS, androstenedione, LH:FSH ratio) and screening for insulin resistance and fasting lipid profile. Management strategies include a low glycaemic index diet, exercise and metformin.
[Summary (SLISE)  ] Dermatology Triples* on DermKnowledgeBASE ]

Ref: Prof Dedee Murrell's article here.

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What is your diagnosis?

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Body Odour

Bromhidrosis

Today a patient came to me with a peculiar complaint. Whenever he goes out he attracts the flies in the vicinity! He has been suffering with this problem for last 7 years. Though he had mild axillary hyperhidrosis, there was no obvious bromhidrosis. Is this a type of bromhidrosis or a delusional state? There is a nice article on bromhidrosis here. According to them 'repopulation' of the intestines with healthy friendly bacteria (good quality Lactobacillus acidophilus and Bifidobacteria) may be helpful in some cases.

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DIG@UTMB

http://digutmb.blogspot.com/
This is a blog for medical students interested in dermatology as well as for dermatologists, residents, patients, and the general public. I posted the link here because the mission of their blog is similar to ours. There is an article in Online journal of dermatology about this blog.

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Penile Lichen Planus

A nice case of penile LP. He had oral lesions and classical lesions over the extremities.
Classical LP papules are commonly found on the penis and mostly occur in a ring around the glans. White streaks and erosive lichen planus are much less common. The above picture shows the white streaks on glans. They are not generally itchy. Thrush is a differential diagnosis. [ Lichen Planus on DermKnowledgeBASE ]

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Skin Condition in a diabetic patient.

This 56 year old obese female patient, diabetic on treatment (but not under good control) for last 7 years presented with these bilateral lesions (more prominent on one leg) since 3 months. What is your diagnosis?
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Steroid-induced acne

This patient is on systemic corticosteroids for treatment of bronchial asthma. Steroid induced acne is a complication of systemic corticosteroids which is characterized by abrupt onset of mildly pruritic monomorphic papules or pustules mainly over the upper trunk. Comedones are absent. Topical retinoids are often used for treatment. Few cases may actually represent pityrosporum folliculitis and may respond to antifungals.
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Steroid Abuse

Steroid abuse is a major problem here. This is one of my patients who swore to me that she does not use anything on her face except a home-made mixture of harmless creams like dermovate which her friend suggested. She says, now that mixture is the only one that can reduce the rash on her face.
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Diagnosis

A solitary firm non-tender nodule of 3 months duration.
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Pompholyx

Recurrent vesiculo-pustular lesions over the fingers were suggestive of pompholyx. KOH was negative. According to the textbooks contact dermatitis has to be excluded when there is sparing of few fingers as in this case. Unfortunately patch testing is not available in our centre.
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My Dip Derm Exam in RCPS Glasgow


This week I was busy with my MOH interview. Hence I dont have any nice case to post. So I thought I will write about how I missed a classical SCLE case in Glasgow for my Dip Derm exam in October 2005.

The mcq exam was on Oct 5 in Glasgow and it was OK for me. I went for the exam with my wife and it was a sort of vacation trip for us. The clinical exam was in Edinburgh on Oct 6.

4 clinical cases were there and the first three went on well. Hence I was partly relaxed when I went for the final case. The fourth patient was a middle aged lady with annular lesions over the upper back and chest. They asked me to take the history. The differentials I had in mind at that moment were disseminated granuloma annulare and extensive tinea corporis. When I started giving my diagnosis I could see that my examiners were not at all impressed. Then finally they asked me to describe the lesions. I started - Annular lesions with minimal itching over covered areas of chest and back. I saw a peculiar expression on my examiners face. One examiner asked me. In your country these are covered areas? Suddenly I knew what I was dealing with and I understood why they were not happy with my history taking. I used to elicit good history from lupus patients during my post graduate days which my professor used to appreciate. Unfortunately I could not use the same skills in this exam.

Though not an excuse for missing such a classical case of SCLE, I think the question of exposed areas is still pertinent. Indian females usually clad in a six meter long fabric called saree. Because of the peculiar way of wearing this outfit the exposed areas in a typical south Indian female are neck and left flank and not chest and upper back.

Incidentally I have published an article on dermatosis in Indian females wearing saree.

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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

Address

Bell Raj Eapen
Hamilton, ON
Canada