SKINTOPICS

  Clinical presentation Easy. Moderate frequency. A 52-year-old patient has had facial lesions for about eight months; they began as small papules and pustules. The patient had tried several topical treatments, but obtained only temporary relief with a cream containing clobetasol 0.05% , initially prescribed for a foot problem. They have been applying it daily to the face for three months. Despite this, the condition continues to worsen and is accompanied by an intense burning sensation. Diagnosis: steroid-induced rosacea-like dermatitis or steroid rosacea. Steroid rosacea Prolonged application of potent topical corticosteroids to the face can cause a condition that mimics or worsens rosacea. It may present with persistent erythema, burning, flushing, papules, pustules, or inflammatory plaques. In some patients, it follows a predominantly perioral, periocular, or perinasal pattern. The corticosteroid initially reduces inflamm...

Clinical question Which topical treatment should I choose for a patient with actinic keratoses? In patients with multiple actinic keratoses on photodamaged skin, the aim is to treat the field of cancerisation , not only the visible lesions. In practice, the choice usually comes down to 5-fluorouracil (5-FU), imiquimod and tirbanibulin. 5-FU is the reference option when efficacy and clinical experience are the priorities. Imiquimod is an established alternative. Tirbanibulin is particularly useful when a very short, well-tolerated course is needed. Before starting. Do not automatically treat a lesion that is indurated, painful, ulcerated, bleeding, markedly hyperkeratotic or clearly different. In these cases, Bowen disease or invasive squamous cell carcinoma should be excluded, and biopsy or referral considered. 1. 5-FU, imiquimod or tirbanibulin 5% 5-FU has the strongest comparative evidence at 12 months: in a direct trial it was more effective than imiquimod and also more cos...

  Controversy Photoprotection and vitamin D: how can we sunbathe safely without falling short Photoprotection is one of the most important measures for preventing cumulative sun damage, premature skin aging, and skin cancer. But a reasonable question often comes up: if we protect ourselves a lot from the sun, can we develop vitamin D deficiency? The practical answer is that it is possible to maintain good photoprotection without giving up adequate vitamin D levels. The key is understanding that we do not need to burn, tan, or spend a long time exposed to the sun in order to synthesize vitamin D. Key point: the goal is not to avoid the sun at all costs, but to avoid sun damage. Exposure should be brief, gradual, adapted to skin phototype, and always avoid sunburn.

  Clinical question When onychomycosis is suspected, should a sample always be collected, or can empirical treatment be started? Onychomycosis is a common cause of nail changes, but not every thickened, yellowish, brittle, or dystrophic nail is infected by fungi. Therefore, when there is clinical suspicion of onychomycosis, the general recommendation is to confirm the diagnosis with a sample, especially if oral antifungal treatment is going to be started. Key point: clinical diagnosis alone has limited value. Many nails with a compatible appearance are not actually onychomycosis. Why is it advisable to confirm the diagnosis? All guidelines recommend collecting a sample, especially before prescribing oral treatment, for two main reasons: Clinical diagnosis alone is unreliable. Only some nails with clinical suspicion are truly fungal. Oral treatment...

  Patient Case Easy. Common 56-year-old woman. She reports the appearance of an itchy patch on her back. She has applied an antifungal and a topical steroid without success. Pigmented/pruritic macule in the dorsal paravertebral region. Most likely diagnosis: notalgia paresthetica. ``` Notalgia paresthetica Notalgia paresthetica is a common cause of localized itching on the back. Although the reason for consultation is often a skin patch, the underlying problem is not primarily dermatological, but neuropathic . It results from irritation, compression, or entrapment of dorsal sensory branches. This may be related to muscle contractures, postural abnormalities, or degenerative changes in the spine and discs that affect these roots or nerves. Key point: skin changes are usually secondary to scratching or repeated manipulatio...