Skin conditions: before and after

Dr Philip Marazzi outlines some commonly presented skin conditions, before and after treatment

Sebo-psoriasis - Before

The patient had this rash for some time before presenting to a doctor. She tried various creams unsuccessfully and she had no history of skin problems. The distribution of the rash was suggestive of seborrhoeic dermatitis, but in fact it was felt by a dermatologist that it was more of a hybrid between seborrhoeic dermatitis and psoriasis, known increasingly as 'sebo-psoriasis'.

Sebo-psoriasis - After

The patient was treated with a course of betamethasone and sodium fusidate. As can be seen, she responded very well with rapid improvement of the rash. The patient was delighted. Following a short course of treatment, the condition appears to have gone into a complete remission.

Pyoderma gangrenosum - Before

This 60-year-old man had a history of type-2 diabetes and peripheral vascular disease. He initially developed a small ulcer, which was treated by the practice nurses in the normal way. Instead of responding, however, the ulcer continued to grow. He also developed another ulcer on his other leg. In view of the rather unusual behaviour of these ulcers biopsies were taken to exclude any possible malignant change. The diagnosis was then confirmed as pyoderma gangrenosum.

Pyoderma gangrenosum - After

This patient has had a difficult time since diagnosis. On one leg, the ulcer spread the whole way round the leg and it appeared likely that he would need amputation. This was not carried out and he had a popliteal artery angioplasty to improve the circulation to the limb and skin grafting to help the ulcer to close over. He has been treated with a variety of dressings and techniques, as well as numerous courses of antibiotics. He is currently on ciclosporin and, five years after the initial diagnosis, he is doing well.

Basal cell carcinoma - Before

This elderly man presented with a small lesion near the nasolabial fold. It had been present for some time and had features of a basal cell carcinoma. The patient was seen by maxillofacial surgeons who agreed with the diagnosis and arranged to excise the lesion.

Basal cell carcinoma - After

Surgical techniques now allow surgeons to excise lesions leaving minimal scarring. This case is a good example, as this picture was taken a little while after the lesion had been excised. When fully healed, the scar was virtually invisible.

Olecranon bursitis - Before

This patient had severe rheumatoid disease. She developed this substantial olecranon bursitis. There was no obvious cause, though it is likely to have followed minor trauma. This condition will often settle down on its own, though patients usually find it uncomfortable and are anxious to have it treated. Olecranonbursitis can be aspirated, though there is a risk of introducing infection. Anti-inflammatory drugs are also often prescribed.

Olecranon bursitis - After

On this occasion, in light of the severe underlying problems caused by the rheumatoid disease, the patient was referred for surgery. Unfortunately the wound dehisced three days postoperatively. It was left to heal by secondary intent, with granulation tissue slowly filling the hole. As can be seen, the wound healed well.

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