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104. Pubic lice

hair, such as moustaches, beards, axillary hair, hair on the chest, abdomen, or back, as well as pubic and perianal hair. The eyebrows and eyelashes can also be affected. The diagnosis is confirmed if visible pubic lice ('crab'-shaped, grey-brown in colour, and about 2 mm in length) or eggs (yellow/white in colour and smaller than a pinhead) are found on examination. Small blue macules (‘maculae cerulae’) or red papules — may be seen at feeding sites. Rust-coloured flecks of faecal material (...) , crusting and matting of eyelashes and conjunctivitis. Visible lice or nits in any area with coarse body hair (most often the pubic area, less commonly the axillae, chest, abdomen, perianal area, beard area, eyelashes and eyebrows). Rust-coloured flecks of faecal material may be seen. Skin lesions such as: Small blue macules (‘maculae cerulae’) or red papules — may be seen at feeding sites. Lichenification and hyperpigmentation of pruritic areas — may occur in chronic infestation. Basis

2018 NICE Clinical Knowledge Summaries

105. Psoriasis

— may mimic flexural psoriasis, but typically presents with bright red papules, pustules, and superficial erosions with satellite lesions. See the CKS topic on for more information. Norwegian scabies — may present with hyperkeratosis similar to that of psoriasis, with genital and axillary fold involvement. See the CKS topic on for more information. Secondary syphilis — consider if there is palmar or plantar involvement with macules, papules, pustules, or plaques, which may mimic localized pustular

2018 NICE Clinical Knowledge Summaries

106. Urticaria

— the early lesions are pruritic and have a similar appearance to an urticarial rash. Polymorphic eruption of pregnancy — urticarial itchy papules mainly occur in the third trimester of pregnancy, often starting on abdominal stretch marks. Urticaria pigmentosa (a form of mastocytosis) — the skin becomes inflamed and red when stroked (Derier's sign) and has hyperpigmented macules and papules. Urticarial vasculitis — lesions remain for longer than 24 hours and are painful, non-blanching, and palpable

2018 NICE Clinical Knowledge Summaries

107. Febrile seizure

sclerosis may be suggested by facial angiofibromas, shagreen or leather patches, periungual fibromas, and hypopigmented macules ('ash-leaf spots'). Neurofibromatosis may be suggested by cafe au lait spots, intertriginous freckling, iris hamartomas, and subcutaneous nodules. Basis for recommendation Basis for recommendation The information on the differential diagnosis of febrile seizure is based on the American Academy of Pediatrics (AAP) clinical practice guideline Febrile seizures: guideline

2018 NICE Clinical Knowledge Summaries

108. Scarlet fever

disappears, leaving the tongue with a beefy red appearance. Swollen cervical lymphadenopathy. Flushed face, with marked circumoral pallor. Pharyngitis, and red macules dotted over the hard and soft palate (Forchheimer spots). Be alert for symptoms and signs of scarlet fever in people who are at increased risk of invasive Group A Streptococcal infection (iGAS) including: Those who are immunocompromised. Those with co-morbidities such as diabetes mellitus. Those with co-existing chickenpox or breaks

2018 NICE Clinical Knowledge Summaries

109. Chickenpox

infection. In immunocompromised people, severe disseminated chickenpox with varicella pneumonia, encephalitis, hepatitis, and haemorrhagic complications. The clinical features of chickenpox include: Prodromal symptoms such as nausea, myalgia, anorexia, headache, general malaise, and loss of appetite. Small, erythematous macules which appear on the scalp, face, trunk, and proximal limbs, and progress over 12–14 hours to papules, clear vesicles (which are intensely itchy), and pustules. Vesicles can also (...) . On examination, look for: Fever. Rash: Small, erythematous macules appear on the scalp, face, trunk, and proximal limbs, which progress over 12–14 hours to papules, clear vesicles (which are intensely itchy), and pustules. Vesicles can also occur on the palms and soles, and mucous membranes can also be affected, with painful and shallow oral or genital ulcers. Vesicles appear in crops; stages of development of the rash can therefore differ on different areas of the body. Crusting occurs usually within 5 days

2018 NICE Clinical Knowledge Summaries

110. Fungal skin infection - body and groin

of atopy. See the CKS topic on for more information. Pityriasis rosea — multiple circular or oval pink-red or fawn-coloured slightly scaly lesions, typically in a symmetrical distribution affecting the trunk and proximal limbs. A larger herald patch usually precedes the onset of the generalized rash. See the CKS topic on for more information. Pityriasis versicolor — well-demarcated multiple round or oval macules of variable colours most commonly on the back, chest, and upper arms. Surface may have (...) : Intertrigo — superficial skin inflammation occurring on two closely-opposed skin surfaces, such as the skin folds. May be due to mechanical causes (such as moisture, friction, or heat), and may have secondary bacterial or candidal infection. The rash is usually uniformly red without central clearing or scale. Candidal infection usually involves the scrotum and may have satellite lesions. See the CKS topic on for more information. Erythrasma — typically small, red-brown macules that may coalesce

2018 NICE Clinical Knowledge Summaries

112. The effect of melasma on self-esteem: A pilot study (Full text)

The effect of melasma on self-esteem: A pilot study Melasma is a common disorder of hyperpigmentation characterized by tan or brown macules and patches affecting sun-exposed areas, particularly the face. Melasma has been shown to have a significant impact on the quality of life and self-esteem of those affected. We interviewed six patients who were diagnosed with moderate-to-severe melasma with regard to the effect of their disorder on their self-esteem. All patients reported a significant

2017 International journal of women's dermatology PubMed abstract

114. Guideline for the Treatment of Acne

Papulopustular acne Most patients have a mixture of non-inflammatory (NIL) and inflammatory lesions [5]. Inflammatory lesions arise from the microcomedo or from non-inflammatory clinically apparent lesions and may be either superficial or deep [6]. Superficial inflammatory lesions include papules and pustules (5 mm or less in diameter). These may evolve into nodules in more severe disease. Inflammatory macules represent regressing lesions that may persist for many weeks and contribute markedly to the general (...) rarely seen. The counting technique involves the direct counting of non-inflamed and inflamed lesions, including superficial papules and pustules, deep inflamed lesions and macules. The revised Leeds acne grading system [19] includes numerical grading systems for the back and chest as well as for the face. The Echelle de Cotation des Lesions d’Acne (ECLA) or “Acne Lesion Score Scale” system has demonstrated good reliability [20]. However, ECLA scores do not correlate with quality of life scores

2016 European Dermatology Forum

115. A Practice Guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: Referral Indications for Cancer Predisposition Assessment

or periungual fibroma • Hypomelanotic macules (=3) • Shagreen patch (connective tissue nevus) • Cortical tuber in the brain • Subependymal glial nodule • Subependymal giant cell astrocytoma • Multiple retinal nodular hamartomas • Cardiac rhabdomyomas, single or multiple • Lymphangiomyomatosis • Renal angiomyolipoma Minor criteria • Multiple, randomly distributed pits in dental enamel • Hamartomatous rectal polyps • Bone cysts • “Confetti” skin lesions • Multiple renal cysts • Nonrenal hamartoma • Cerebral

2015 American College of Medical Genetics and Genomics

116. An Australian guideline on the diagnosis of overseas acquired Lyme Disease/Borreliosis

bite and resolves spontaneously in a few weeks or months (8). The rash is present in 70 to 80 per cent of infected persons. The rash begins at the site of the tick bite as a red macule or papule, rapidly enlarges and sometimes develops central clearing but is often homogenous (1, 7). The advancing edge is typically distinct and is often intensely coloured but not markedly elevated (10). The duration of the rash is usually dependent on the infecting genospecies but will last approximately 4 to 14

2015 Clinical Practice Guidelines Portal

118. Combination of Oral Tranexamic Acid with Topical 3% Tranexamic Acid versus Oral Tranexamic Acid with Topical 20% Azelaic Acid in the Treatment of Melasma. (Full text)

(based upon history and the clinical findings of symmetrically distributed hyperpigmented macules and patches on the face), aged 12 to 50 years, were selected. The cases were divided into two groups by simple random sampling method. The cases in group A were treated by oral tranexamic acid (250 mg twice daily) with topical 3% tranexamic acid (twice daily). In group B, cases had oral tranexamic acid (250 mg twice daily) with topical 20% azelaic acid (daily) for six months. They were followed every

2019 Journal of the College of Physicians and Surgeons--Pakistan : JCPSP Controlled trial quality: uncertain PubMed abstract

119. Efficacy of Azole Antifungal in Treatment of Pityriasis Versicolor. (Full text)

weeks (Category 3). Clinical (colour of macule, scale, pruritus) and mycological assessment were done after 4 weeks of therapy.After 4 weeks of treatment, clinical cure was observed in 62.4% (Category I), 36.3% (Category II) and 37.5% (Category III).It was reported in our study that the most effective regimen for PV patients is fluconazole 300 mg per week combined with ketoconazole 2% twice a week for 2 weeks.

2019 Open access Macedonian journal of medical sciences Controlled trial quality: uncertain PubMed abstract

120. Erdheim-Chester Disease: Expanding the spectrum of cutaneous manifestations. (Abstract)

common finding being subcutaneous nodules (n=5). A single patient presented with granuloma annulare-like lesions. Another patient with mixed ECD and Langerhans cell histiocytosis presented with lightly scaling, pink-red macules. In three patients, skin lesions were the first manifestation of the disease. Most patients presented with bone/extremity pain, weight loss and other constitutional symptoms at the time of diagnosis. BRAF-V600E mutation was not found in patients with panniculitis-like

2019 British Journal of Dermatology

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