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For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.
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What is this condition?
This is perioral dermatitis affecting paranasal skin and chin ("muzzle rash"). There are asymmetrical clusters of slightly scaly papules on an erythematous base. The skin immediately adjacent to the vermilion of the lip is relatively spared.
What may have caused it?
The rash may have been provoked initially by a face cream such as a moisturiser or sunscreen. Applying a potent topical steroid will have made it significantly worse.
How should it be treated?
Perioral dermatitis responds well to oral tetracycline, or one of its derivatives, taken for one to three months. Oral erythromycin may also be useful. Topical antibiotics are less effective. Topical azelaic acid may be helpful.
The patient should be encouraged to discontinue all face creams and make-up and to cleanse her face with a mild soap and warm water twice daily.
The rash may flare severely on discontinuing topical steroids, so if necessary a lower-potency product such as hydrocortisone cream could be applied for a couple of weeks until the tetracycline has proved effective.
Topical steroids should always be used with caution on the face.