By Dr Nigel Stollery
By Dr Nigel Stollery
In entropion, the lower eyelid, or less commonly the upper one, as shown here, turns inward causing the lashes to rub against the cornea. The condition is painful and in the long term can cause scarring of the cornea and eventually interference with vision. In extreme cases it can result in blindness. Entropion usually occurs as part of the normal ageing process in western countries. However, in the third world it may result from chronic infection with trachoma. Simple treatment includes regular plucking of the eyelashes but this is only a temporary measure and needs to be repeated regularly. More permanent treatment usually involves surgery. One novel and very successful procedure involves the grafting of oral mucosa onto the affected lid which lifts the lashes away from the cornea.
Seborrhoeic keratoses (warts), also known as basal cell papilloma, are very common skin tumours in people with light skin (Fitzpatrick skin types I-III). They may be solitary or multiple and numbers increase with age. The warts are caused by a failure of keratinocyte maturation which results in the accumulation of immature, benign cells within the epidermis. Treatment is usually requested for cosmetic purposes as the warts can be very unsightly. Treatment options include excision, curettage and cautery or cryotherapy.
In the early stages of Dupuytren's contracture localised thickening of the palmar fascia causes nodules to develop. In most cases this does not interfere with function. However, as the condition progresses, contractures can occur which cause fixed flexion deformities. It is usually at this stage, when the finger can no longer be straightened, that help is sought. The condition is more common in men over 40 and in some cases may be hereditary or associated with epilepsy or alcoholic cirrhosis. In most cases, excision of the affected palmar fascia is the treatment of choice.
Erythema ab igne
Erythema ab igne has a very distinctive appearance with a characteristic reticular pattern. It is caused by long-term exposure of the skin to heat, most commonly from electric, gas or open fires or the direct application of hot water bottles to the skin. The patient often has an underlying condition, such as a bad back or osteoarthritis of a joint, which is helped by the heat.
The trend in the post-war years for adolescent girls to wear very pointed shoes with high stiletto heels is thought to have contributed to an increasing incidence of hallux valgus, or bunions, among today's ageing female population. The condition is usually progressive with a drifting of the proximal phalanx leading to an uncovering of the metatarsal head resulting in the formation of a callus or bunion. Further lateral drift may then cause the second toe to elevate and ride over the great toe. In more severe cases the toe may dislocate leading to osteoarthritis of the metatarsophalangeal joint which causes increasing pain and discomfort. There are many different surgical options to treat this condition including Keller's arthroplasty and Mitchell's osteotomy.
Chondrodermatitis nodularis chronica helicis
I always enjoy impressing my patients by making a diagnosis of chondrodermatitis nodularis chronica helicis. It must be the longest name of the common dermatological conditions. This benign condition occurs in one of the high-risk areas for squamous cell carcinoma and is caused by an inflammatory reaction in which painful nodules develop on the helix and antihelix. It is more common in men than women and more painful in colder weather. Pain is also noticed when pressure is applied to the nodules for example by pillows at night. This problem can be avoided by using adapted pillows with central hollows. Treatment is not always necessary. Cryotherapy can be helpful, although steroid injections or formal excision are more common choices. The procedure I use is to open the skin, excise the underlying cartilage and then close the skin, without actually removing any skin.Entropion Seborrhoeic warts Erythema ab igne Hallux valgus Author
Dr Nigel Stollery
MB BS DPD
GP, Kibworth, Leicestershire and clinical assistant in dermatology, Leicester Royal Infirmary