Dermatology
Cultura
Dermatology
Professor Dedee Murrell
A photosensitive rash
most appropriate agent. The tears need to be used as required, not at fixed intervals, as requirements will vary day to day. Failure to maintain good ocular hydration can lead to corneal ulceration and permanent scarring.
Hannah will need to be particularly careful on windy days or when she is near a strong fan. A poor response to conservative treatment might suggest the need for tiny silicon plugs to be inserted in the lacrimal ducts, reducing drainage of tears.
Extra-exocrine complications can be profound and she should be followed-up by a specialist who has an interest in the condition.
Outcome These two episodes of severe facial pain spur Hannah into improving her lifestyle. However, her parotid swelling persists and she is occasionally aware of an
Cultura
App of the Week
CULTURAL awareness is an important skill for any GP. But this app targets something specific— dementia and ageing in different cultures.
Cultura, developed by Alzheimer’ s Australia SA, has comprehensive information on more than 20 cultures. This includes useful information on interacting politely, such as how much personal space to give and accidental gestures.
But it also contains information on how different cultures manage residential care, end-of-life care and pain. Some cultures value stoicism, which makes individuals less likely to request analgesia. Some fear residential care, while
ongoing foul taste associated with intermittent discharge from her parotid glands. In part 2 next week, we discuss new twists in Hannah’ s case. ●
Reference
1. Arthritis Care and Research 2012; 64:475-87.
DIAGNOSTIC CRITERIA FOR PSS
CASE definition requires at least two out of the following three:
1. Positive serum anti-SS-A and / or anti-SS-B or positive rheumatoid factor and ANA ≥ 1:320
2. Ocular staining score ≥ 3
3. Presence of focal lymphocytic sialadenitis with focus score ≥ 1 focus / 4mm 2 in labial salivary gland biopsies. 1 others don’ t. GPs are unlikely to find this specific information serendipitously, making this app a useful source of information.
Specifications
COST: FREE COMPATIBLE WITH: Apple IOS 8.0 or Android 4.1
A 75-YEAR-old woman presented with a three-month history of a photosensitive rash on the face, neck, upper chest and back, and the extensor areas of the upper limbs. On examination, she had multiple erythematous scaly photodistributed papules and plaques. The rash had not improved with treatment with topical steroids and low-dose prednisone.
Professor Dedee Murrell is head of the department of dermatology at St George Hospital, Sydney, and the University of NSW.
This article was co-authored by Dr María Adriana Castrillón, a visiting dermatologist from Clínica Alemana de Santiago, Chile.
THE QUIZ
Q. What are the differential diagnoses? a) Allergic contact dermatitis( ACD) b) Polymorphous light eruption( PMLE) c) Subacute cutaneous lupus( SCLE) d) Solar urticaria( SU) e) Psoriasis A. The answer is b and c. ACD and psoriasis do not present exclusively on photo-exposed areas and SU presents as hives without scale. This patient had SCLE.
Q. Which of the following are necessary to confirm cutaneous lupus? a) Lesional skin biopsy b) Direct immunofluorescence( DIF) A. The answer is a. In general, a positive DIF supports the diagnosis of cutaneous lupus, but a negative DIF does not exclude the condition. When routine histopathology is equivocal, DIF can help establish the diagnosis.
Q. Which of the following are usually positive in patients with SCLE? a) ANA b) anti-Ro / SS-A c) ANCA d) anti-dsDNA A. The answer is a and b. ANA is positive in 70-80 % of SCLE patients and anti-Ro / SS-A antibodies are present in 70 %. Only 5 % of SCLE patients have anti-dsDNA antibodies. ANCA is positive in patients with vasculitis-ANCA associated SCLE.
Q. Which percentage of SCLE patients meet the diagnostic criteria for SLE? a) 5 % b) 10 % c) 50 % d) 80 % A. The answer is c. Patients with SCLE usually have only mild systemic symptoms. Less than 10 % have severe systemic symptoms.
Q. Which of the following is first-line treatment for this patient’ s rash? a) Methotrexate b) Mycophenolate mofetil c) Hydroxychloroquine d) Dapsone e) Systemic corticosteroids A. The answer is c. Antimalarials are considered first-line therapy for all subtypes of cutaneous lupus. The recommended adult dose is 6-6.5mg / kg ideal body weight per day.
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