Case 9, spot diagnosis...

موضوع: Case 9, spot diagnosis... الجمعة أبريل 17, 2009 3:35 pm

Case 9

This is a very common skin condition

We,regardless our specialty, must be aware of its diagnosis and treatment

Moreover, your patient will be happy and satisfied with the results

Questions:

What is your diagnosis?

What is your plan of management?

is it vitilgo?
if it is right
it is treated by ultraviolet rays or by injection of materials that make the patch darker

Sorry, false answer.

In vitiligo, the lesions are depigmented and appear milky
white,and the lesions here are only hypopigmented.

Moreover,vitiligo is not so common,and not commonly
treated by injectables and the patient most probably
won't be so happy with the results

I am talking about a condition that is very common,and many
of us may have suffered from it oneday (but not me Smile

)
!

Thank you very much for your active participation.

Hint:Notice the distribution of the lesions which is long jacket ,short sleeve

i think it pitrysis alba

Unfortunately, again this is a false answer

I am very annoyed that you couldn't reach the diagnosis of
this easy condition
Evil or Very Mad

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Can anyone make me smile again
??

طب سبنا شويه نفكر يا محمد اصل مش بحب الجلديه

دى سهلة جدا pytriasis rosea
لان فى نوع بيبقى hypopigmented صح؟ يارب ترجع ابتسامتك يا دكتور محمد Smile

Sorry, please try again

When you reach the diagnosis, we may discuss the
differential diagnosis that includes the conditions you have
mentioned

sorry

انا قصدى pytriasis versicolor
يا رب يا رب تطلع صح

والله انا كمان كان قصدي دي

Excellent,it is pityriasis versicolor-hypopigmented type

Please note the correct spelling

Now what is your management

??

After you answer this question, I will give a short hint on this
condition and the various topical or systemic
preparations used in its treatment

Topical choices:
1. ketoconazole (nizoral) 2% shampoo applied to the skin, allowed to dry, and left on overnight as a single dose or daily for 3 consecutive days.
2. Ciclopirox (Loprox) shampoois effective when left on for several minutes before rinsing – 2 week duration
3. Antifungal creams or solutions, including all imidazoles, allylamines, haloprogin, tolnaftate, applied for b.i.d. (i.e. twice a day) for 2 weeks.
4. Zinc pyrithione is found in many shampoos (including Head And Shoulders!), applied 5 minutes daily for 2 weeks.
5. Selenium sulfide suspension, applied and left on for 5 – 10 minutes before rinsing, 7 – 14 days duration.
6. Keratolytic creams, ointments, or lotions containing 3% - 6% salicylic acid applied overnight for 1 – 2 weeks.
7. Retinoic acid cream (Retin-A cream) applied b.i.d. for 2 weeks ( it may lighten pigmentations once it is applied thus it is helpful for thoses who are distressed with hyperpigmented lesions).
8. Sodium hyposulfite 25% applied to the lesions b.i.d. for several weeks
Systemic:
1. Fluconazole, single oral dose of 400 mg, a second dose may be needed one week later.
2. Itraconazole 200mg daily for 5 – 7 days
3. Ketoconazole 400mg, single dose – equivalent to fluconazole.
Source: manual of dermatologic therapeutics 7th ed.
I really don’t know what option is widely used in Egypt, I just copied these options from my book and I think Dr Mohammad may give us a more specific answer.

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