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Simple cases
Case 8
45-year-old patient complains of scales on his face and chest
History
Do these lesions itch or burn?
No, but they sure bother me cosmetically.
Most often this disease with oily yellow scales is asymptomatic but cosmetically distressing.
Have you ever had the same rash elsewhere?
Yes, in the past, my chin and forehead were involved?
The areas of predilection include the scalp, hairline, eyebrows, nasal folds, chest and intertriginous areas (axillae, umbilicus). Not all areas are involved in all patients at same time.
Do you have any allergies?
Yes; I can't wear watches with nickel armbands.
This question doesn't help much in this setting.
Do you have pets at home?
Yes, we have a cat.
Good question. When scales are present, always think of a tinea. Fungal infections may be transferred from pets. If the pet has signs or symptoms, they too should go to the doctor (veterinarian).
Does anyone else in the family have similar problems?
No, I am the only one with scales.
The question is good if you are further suspicious of tinea; otherwise, it doesn't help for this non-contagious disorder.
Have you ever found any ointments or creams that helped?
Have you ever found any ointments or creams that helped?
Good question which can help you plan your therapeutic approach.
Lesion
Choose the right efflorescences:
Correct. Oily yellow scales are seen.
False. Papules are not part of this disease.
False. This disease does not lead to ulcers.
Correct. Flat erythematous lesions are seen.
Diagnosis
Choose the right diagnosis:
False. Always part of the differential, but the location and morphology (greasy scales) do not fit.
False. The lesions are too symmetrical. KOH examination and fungal culture can be performed to be certain.
Correct. The clinical picture is typical. Tape stripping may reveal Pityrosporon ovale spores; this common lipophilic fungus may be a co-factor.
False. Sometimes the distinction can be difficult, but here no thick silvery scales on an erythematous base are seen.
Therapy
Choose the right therapy(ies):
They help control the acute inflammation but should not be used for long periods.
Treatment of choiceavailable as shampoos, lotions, or creams.
Also effective, especially on the scalp; no longer widely available
Useful for reducing marked scaling on the scalp.
