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GPs share their photos of interesting infections

Pityriasis versicolor from tribal markings

This young man from South Africa consulted me because of a truncal rash.

He has pityriasis versicolor which is difficult to see in dark-skinned people and has tribal markings which are these symmetrical scars overlying the scapulae and around his lumbar region.

He also has a chest drain scar and a laparotomy scar following a knife attack in Johannesburg which caused a haemopneumothorax and intra-abdominal injuries.

Dr Andy Jordan, a committee member for the

Primary Care Dermatology Society and a GP in Chesham, Bucks

The ‘Grim Reaper' with pityriasis versicolor

This patient was concerned about a rash on his upper back.

I was a bit surprised when I examined him to come face-to-face with the Grim Reaper!

He (the patient, not the Grim Reaper) had fawn-coloured patches that were non-itchy but long-standing.

Treatment is in the form of topical selenium sulphide (Selsun shampoo) or topical presentation of the imidazole group of antifungal drugs.

Oral itraconazole can also be used.

Dr Koshy Johnson, GP in Hull

Onychomycosis

This woman was fed up of always having to apply nail varnish to cover her discoloured nails.

She was getting so frustrated that she was entertaining thoughts of pulling her nails out! Fungal nail infection may occur as a primary event or following other disease or damage to the nail.

Treating these infections can be difficult and spontaneous resolution is rare. Toenails are more commonly involved than fingernails. Discolouration varies and appearance might range from mild pitting to complete nail destruction.

Diagnosis is confirmed by sending nail clipping/scraping for microbiological diagnosis.

Dr Siddapa Gada, GP in Coventry

Perichondritis

This woman presented with pain in her ears that had started two days ago and had become so severe she was now having trouble sleeping.

This is a classical case of perichondritis – an infection of the skin and layer of tissue around the cartilage – with sparing of the ear lobule.

When an infection involves the cartilage, it is called chondritis. The most common cause of perichondritis is following trauma or high piercing of the ear.

The usual culprits are staphylococci aureus and pseudomonas aeruginosa. The sooner the antibiotics are started the better the results. Delaying treatment makes the risk of subperiosteal abscess high.

This is not only very painful but can also lead to loss of cartilage and to an unsightly deformity commonly known as ‘cauliflower ear', which has a poor chance of good reconstruction.

This woman recovered fully without any deformity with a one-week oral course of ciprofloxacin.

Dr Siddapa Gada, GP in Coventry

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