CPD SPOT DIAGNOSIS ,

Spot Dx — A COVID clue, itchy skin, and a mid-swim sting

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: DER011

ACRRM Activity Number: DER011

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1. Is COVID a clue to this itchy crease?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 29-year-old female of Chinese descent presents to the dermatologist with a three-month history of an itchy antecubital rash bilaterally.</p><p>Following the COVID-19 pandemic, she had begun washing her wool jumpers using an antifungal and antibacterial laundry product.</p><p>Her GP had prescribed oral prednisolone 25mg for four days, topical corticosteroids twice daily and moisturiser. The rash persisted despite these treatments.</p><p>She has a previous history remarkable only for urticaria in childhood. She has no known allergies. There is no family history of skin disease.&nbsp;She lives alone with no pets.</p><p>On clinical examination, there is a red-brown, scaly, symmetrical rash in her cubital fossae bilaterally.&nbsp;</p></p> <ul> <li>a. Atopic dermatitis</li> <li>b. Tinea corporis</li> <li>c. Psoriasis</li> <li>d. Granular parakeratosis</li> </ul> </section> <p></p>

Photo: Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at UNSW Sydney.

2. Can you nail down the cause of this foot rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 40-year-old woman of Iranian heritage presents to a dermatologist with a persistent, scaly, pruritic rash on her feet that she has had for many years. There is no rash elsewhere on her body. </p><p>She has previously been diagnosed with palmoplantar psoriasis and prescribed topical steroid creams, including betamethasone and oral prednisone. She also received ultraviolet light treatment. There was no improvement with any of these treatments. </p><p>She has no known allergies. Her cousin, sister and uncle have psoriasis. She lives at home with her husband and children and has a pet dog.</p><p>On examination, there is a well-demarcated erythematous rash on both, more marked on the left foot. This is associated with a yellowed, dysmorphic right toenail.</p></p> <ul> <li>a. Palmoplantar psoriasis</li> <li>b. Tinea pedis</li> <li>c. Dry discoid eczema</li> <li>d. Granuloma annulare</li> </ul> </section> <p></p>

Photo: Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at UNSW Sydney.

3. Pain, pruritus and plaques: what's at play?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Katie, a 54-year-old postmenopausal chemical engineer, presents with several months of progressively worsening pruritis affecting the vulva, perianal region and natal cleft (pictured).</p><p>She has tried treating this with a topical antifungal, but this has not helped. The intense itch is affecting her ability to work and sleep. She also has new dyspareunia and a first episode of anal fissure.</p><p>She is usually well, with a background of Hashimoto’s thyroiditis, euthyroid on 50µg levothyroxine daily, her only medication.</p><p>There are no new exposures and no close contacts are affected.</p><p>On examination, there are white plaques on both labia minora, extending to the perineum and the natal cleft, and an anal fissure. </p></p> <ul> <li>a. Inverse psoriasis</li> <li>b. Undertreated candidiasis</li> <li>c. Lichen sclerosus</li> <li>d. Scabies</li> </ul> </section> <p></p>

Photo reproduced from BMJ, P Sharma, 373:n1012 2021 with permission from BMJ Publishing Group Ltd.

Author

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

4. What's this stubborn rash post-waxing?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 17-year-old male presents with a one-year history of a pruritic rash on his face.</p><p>He reports the intermittently pruritic and non-painful rash appeared within weeks of receiving an eyebrow waxing treatment.</p><p>The patient is otherwise well with no known allergies or significant past medical history.</p><p>There is no family history of atopy, psoriasis or autoimmune conditions. The patient is a full-time student and has no pets.</p><p>Examination demonstrates a well-demarcated erythematous patch with overlying scale lateral to the right eye (pictured) and central forehead.</p><p>There is mild bilateral cubital fossa erythema, consistent with chronic eczema. There are scant open and closed comedones on the central forehead and upper back.</p></p> <ul> <li>a. Tinea faciei</li> <li>b. Dermatitis</li> <li>c. Psoriasis</li> <li>d. Rosacea</li> </ul> </section> <p></p>

Photo: Professor Dedee Murrell

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at UNSW Sydney.

5. Can you finger this stinger?

What is the most likely diagnosis?

Author

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

6. What's behind this holiday rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Jenny is a 42-year-old office manager who presents with a linear itchy rash on the abdomen and left calf.</p><p>She noticed this just as she was boarding the plane back to Australia after a three-week holiday in Europe.</p><p>The flight was uncomfortable because of the intense pruritus. Her husband has similar lesions on his legs.</p><p>Jenny is generally well, with no past or dermatological history of note. On examination she appears well, is afebrile, and has 2-5mm wheals, in a linear distribution on the abdomen (pictured) and similar appearing lesions on the left calf.</p><p>There is a small punctum visible at the centre of a number of these lesions. The cubital fossae, wrists and finger webs are spared.</p></p> <ul> <li>a. Scabies</li> <li>b. Spontaneous urticaria</li> <li>c. Dermatitis herpetiformis</li> <li>d. Bed bug bites</li> </ul> </section> <p> </p> <p> </p> <p></p>

Photo: Dermnet NZ

Author

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

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