CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER001

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: DER001

ACRRM Activity Number: DER001

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1. What’s the cause of this scrotal rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Wayne, a 40-year-old disability support pensioner, attends his GP complaining of a longstanding scrotal rash.&nbsp;His carers report that he often spends most of the day with his hands down in his pants, despite being repeatedly prompted to stop this. This has been an ongoing phenomenon for at least 12 months.</p><p style=”text-align: start”>Wayne reports his “nuts are always itchy” and he can’t help but want to scratch.&nbsp;Over-the-counter antifungal creams have been used before without any impact. Wayne has also previously been prescribed antibiotics by another GP when, after scratching, he broke the skin resulting in a localised infection.&nbsp;</p><p style=”text-align: start”>Topical cortisone has also been prescribed, and Wayne reports good symptomatic relief when using this.</p><p style=”text-align: start”>Wayne has schizophrenia, anxiety and OCD. He lives in a group home and requires round-the-clock care. His schizophrenia has remained stable since being placed on a community treatment order and having monthly paliperidone injections. His only other regular medication is sertraline, which works well for his anxiety.</p><p style=”text-align: start”>His carer advises that Wayne has not used any new products or types of underwear since before the onset of rash.&nbsp;Wayne’s GP arranges skin scrapings for fungal cultures, and these prove negative.&nbsp;His physical examination is unremarkable other than scrotal rash seen in the picture below.</p></p> <ul> <li>a. Candida infection</li> <li>b. Prurigo nodularis</li> <li>c. Lichen simplex</li> <li>d. Pemphigoid nodularis</li> </ul> </section> <p></p>Photo: Dermnet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

2. Which condition rings true?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Siobhan is a 44-year-old who presents with itchy annular plaques on the abdomen, chest, neck, shoulders and back (pictured).<br><br>These began several months ago as erythematous plaques on the abdomen, gradually increasing in number and expanding from the centre. Oral antihistamines, topical steroids and topical antifungals have had no effect.<br><br>There is no clear contact precipitant and no recent medication use. Siobhan is usually well but has a strong family history of type 2 diabetes and, on recent routine blood testing, was found to have a newly elevated HbA1c of 7.4%.<br><br>Pathology was otherwise normal.&nbsp;</strong></p></p> <ul> <li>a. SLE</li> <li>b. Tinea corporis</li> <li>c. Generalised granuloma annulare</li> <li>d. Sarcoidosis</li> </ul> </section> <p></p>Photo: Reproduced from BM J, Liu W, Ma D; 378 :e067430, 2022 with permission from BMJ Publishing Group Ltd.

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

3. More than a bruise?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Harold, 82, attends with an enlarging dusky-coloured lesion on his scalp. His wife, Kay, accompanies him.</strong></p><p style=”text-align: start”><strong>They initially thought the lesion was just a bruise, although Harold could not recall a history of injury or trauma. He is, however, taking warfarin for AF and bruises fairly easily.&nbsp;</strong></p><p style=”text-align: start”><strong>The lesion has been slowly increasing in size and has now become firm with some ulceration, prompting Kay to bring him in. It is slightly tender to the touch and bleeds intermittently with contact.&nbsp;</strong></p><p style=”text-align: start”><strong>Kay has been applying antibiotic ointment to the lesion, with no effect.</strong></p><p style=”text-align: start”><strong>Harold has had multiple skin cancers removed in the past, including a prior excision on the scalp that required skin grafting.</strong></p></p> <ul> <li>a. Pyogenic granuloma</li> <li>b. Cutaneous angiosarcoma</li> <li>c. Infected bruise/haematoma</li> <li>d. Squamous cell carcinoma</li> </ul> </section> <p></p>

Author

Author: Dr Ryan Holmes is a GP in Bondi Junction, Sydney.

4. What’s the cause of pruritus?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>The patient is a 72-year-old teacher who presents with pruritus affecting his upper back and scalp for the past seven days after cleaning a chicken coop.</strong><br><br><strong>The pruritus causes him to scratch, resulting in excoriation. The itch disturbs his sleep and makes focusing on daily tasks difficult. He reports that he has previously had similar symptoms which have been self-limiting, resolving after a few weeks, but has not previously sought medical attention.</strong><br><br><strong>He is not aware of any close contacts with similar symptoms.</strong></p><p style=”text-align: start”><strong>On examination, there is excoriation and erythematous papules and erosions on the back and scalp, with crusting and hypopigmented patches surrounding the sites of excoriations. The digital webs and groin are spared. There are no signs of bleeding or dermatitis.</strong></p></p> <ul> <li>a. Lichen simplex chronicus</li> <li>b. Prurigo nodularis</li> <li>c. Chicken lice infestation</li> <li>d. Scabies</li> </ul> </section> <p></p>Photo: Provided courtesy of Professor Dedee Murrell.

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at UNSW Sydney. This article was co-authored by Henry Tseng, a medical student at UNSW Sydney, and Dr Corey Stone, a dermatology research fellow at Premier Specialists, Kogarah, NSW, and St George Hospital, Sydney.

5. Are these lesions cause for alarm?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Jonah, a 20-year-old mechanic, presents to his GP concerned about lesions on his penis.</p><p style=”text-align: start”>He first noticed them a few months ago and reports they are neither itchy nor bothersome.&nbsp;</p><p style=”text-align: start”>However, he is worried that future partners might find them unsightly — should they be intimate.</p><p style=”text-align: start”>His last sexual health screen was six months ago and was entirely negative. Jonah reports having had no unprotected intercourse in the past year.</p><p style=”text-align: start”>Jonah has no medical history of note and takes no medications.</p><p style=”text-align: start”>He initially tried chlorhexidine body wash on the lesions as he thought they were secondary to poor hygiene, but this did not help. Jonah later tried some topical antifungal creams after discussing this issue with his local pharmacist, and again, this had no impact on the condition, causing his frustrated and anxious state.</p><p style=”text-align: start”>On examination, rows of small dome-shaped skin-coloured bumps are noted on the coronal margin of the glans penis (pictured). The remainder of his examination is unremarkable.&nbsp;</p></p> <ul> <li>a. Fordyce spots</li> <li>b. Molluscum contagiosum</li> <li>c. Pearly penile papules</li> <li>d. Condyloma acuminata</li> </ul> </section> <p></p>Photo: DermNet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

6. Pruritic rash puzzles patient

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Sally, 41, presents with a pruritic erythematous submammary (pictured) and axillary rash. This has been present for the past two months.</span></p><p><span style=”font-size: 14px”>Sally has tried an over-the-counter topical antifungal, but this has not helped. She denies using any new medicines or skin care products.</span></p><p><span style=”font-size: 14px”>Sally is generally well, with Crohn’s disease that is well controlled with infliximab. There is no family history of note.</span></p><p><span style=”font-size: 14px”>Examination is unremarkable apart from the rash pictured with similar bilateral axillary lesions, which do not fluoresce on Wood’s lamp examination. Fungal microscopy and bacterial culture are negative.</span></p></p> <ul> <li>a. Impetigo</li> <li>b. Inverse psoriasis</li> <li>c. Erythrasma</li> <li>d. Candida</li> </ul> </section> <p></p>Photo: Reproduced from BMJ, Feng B et al; 375 :e068621, 2021 with permission from BMJ Publishing Group Ltd

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

References on request from kate.kelso@adg.com.au