CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER004

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: DER004

ACRRM Activity Number: DER004

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1. What is this itchy, scaly rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 19-year-old university student of Asian descent presents with diffuse pruritus, lichenification and erythema over his face, trunk, back, upper and lower limbs. On examination, there are erythematous, scaly papules and plaques affecting his whole body. This has developed over the past few years and he has recently been experiencing severe, intermittent flares. There is no personal or family history of atopy and he is otherwise well. He has been trialled on topical corticosteroids with limited relief and started on UV phototherapy. He occasionally drinks herbal tea and takes vitamin C supplements. He does not smoke or drink and currently lives with his family. No-one else at home has been affected.</strong></p></p> <ul> <li>a. Psoriasis</li> <li>b. Atopic dermatitis</li> <li>c. Scabies</li> <li>d. Urticaria</li> </ul> </section> <p></p>

Author

Author: Professor Dedee Murrell is head of the department of dermatology at St George Hospital, Sydney and conjoint professor at the University of NSW. This article was co-authored by Madeline Wang, a medical student at the University of NSW, and Dr Anna Wilson, a clinical research fellow at St George Hospital.

2. What's driving these purulent intertriginous fistulae

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 32-year-old retail worker of Vietnamese descent presents with seven draining fistulae and open comedones in the left axilla and six draining fistulae in the right groin. A purulent bloody mixture is exuding from the lesions and bands of severe scar formation are present. The lesions are painful, tender and malodorous. They initially developed seven years ago and have since been regressing and reappearing every two months, approximately two nodules at a time. The nodules typically last for seven days, and either subside or progress to form abscesses that drain onto the skin. He has obesity (BMI 31.2kg/m2) but is otherwise well. His only regular medication is ibuprofen to manage pain associated with his skin condition and he has no known allergies. There is no significant family history and the patient does not smoke or drink alcohol. He is married with no children.</strong></p></p> <ul> <li>a. Furunculosis</li> <li>b. Cutaneous Crohn’s disease</li> <li>c. Granuloma inguinale</li> <li>d. Hidradenitis suppurativa</li> </ul> </section> <p></p>

Author

Author: Professor Dedee Murrell is head of department of dermatology at St George Hospital, Sydney, and conjoint professor at the University of NSW. This article was co-authored by Darby Boucher, a medical student at the University of NSW, and Dr Anna Wilson, a clinical research fellow at St George Hospital.

3. What’s behind this hairy, brown lesion?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Patrick, a 14-year-old budding basketball player, presents complaining of an expanding brown patch on the back of his left shoulder. The lesion appeared a year ago and, over the past few months, has developed some coarse, long hairs. He has also started to experience some anxiety regarding the patch; a few teammates have mocked him, and he finds the area unsightly. Patrick has no other significant medical history and takes no medications. He reports that he has always utilised good sun protection measures when at the beach.</strong></p></p> <ul> <li>a. Congenital melanocytic naevus</li> <li>b. Becker’s naevus</li> <li>c. McCune–Albright syndrome</li> <li>d. Plexiform neurofibroma</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.

4. Was this health kick a rash move?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Lin is a 26-year-old lawyer who presents with several weeks of itchy raised rash on her back and abdomen. She has trialled over-the-counter antifungals and anti-inflammatories without effect. She has not recently changed any laundry or skin care products. Lin takes no regular medications and has no known allergies. She has no past history of note and is generally very well. In fact, she reports she’s been on a health kick since the start of the year, seeing a personal trainer twice a week and adhering to a strict ketogenic diet, at her trainer’s recommendation. Examination findings are unremarkable apart from the rash, pictured.</strong></p></p> <ul> <li>a. Atopic eczema</li> <li>b. Contact dermatitis</li> <li>c. Heat urticaria</li> <li>d. Prurigo pigmentosa</li> </ul> </section> <p></p>Reproduced from The BMJ, Yan Qi-Zeng et al, 375:n2502; 2021 with permission from BMJ Publishing Group Ltd.

Author

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

5. Can you shed some light on these nail changes?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Ross is an active 75-year-old retiree who complains that most of his toenails and his left thumb nail have become discoloured and loose in the past few weeks. He usually enjoys excellent health. Ross has recently recovered from cellulitis of the right leg (two months previously), which resulted from walking into a small rusty metal crucifix when exploring a country cemetery. He was intially treated with oral cefalexin, changing to oral flucloxacillin five days later because of failure to respond. The cellulitis settled well with 10 days of further antibiotic therapy. He takes no regular medications, has no known allergies and remains systemically well. On examination, the only findings of note are the affected nails, which exhibit painless proximal nail detachment with new healthy nail just visible beneath the affected areas.</strong></p></p> <ul> <li>a. Onychomycosis</li> <li>b. Yellow nail syndrome</li> <li>c. Onychomadesis</li> <li>d. Psoriasis</li> </ul> </section> <p></p>

Author

Author: Emeritus Professor Max Kamien is a senior honorary research fellow, University of WA.

6. Why is this man’s nipple swollen and itchy?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Eric is a 52-year-old office worker who presents with an itchy right nipple. This has been present for about a month, and due to scratching, the nipple has become swollen and oozy (pictured). He has a past history of allergic rhinitis but not eczema. He denies any recent potential irritant or allergen exposure. On examination, the right nipple and areola are erythematous, thickened and excoriated. The left nipple is normal, and breast and axillary examination is normal bilaterally. Mammography and ultrasonography show thickened right areolar skin only. A right areolar punch biopsy reveals epidermal hyperplasia, hyperkeratosis/parakeratosis, and spongiosis with subepithelial inflammation. Culture reveals a light growth of Staphylococcus aureus.</strong></p></p> <ul> <li>a. Paget’s disease of the nipple</li> <li>b. Candidiasis</li> <li>c. Atopic dermatitis</li> <li>d. Psoriasis</li> </ul> </section> <p></p>Photo: Reproduced from BMJ, Abudhaise H et al. 373:n750 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