Mixed diagnoses – 10 cases (9 of 11)

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.

When you finish the quiz, you can download a certificate.

Case 4

This twenty eight-year-old bank clerk has had the irritable rash shown for several days. It affects her hands, forearms and feet. She is spending her summer holiday at the beach.

Polymorphous light eruption (PMLE).

Unaccustomed exposure to the sun; both long wave ultraviolet radiation (UVA) and short wave ultraviolet radiation (UVB) may be responsible. PMLE usually occurs after several days of sun exposure, and may occur even in those using sunscreens. It generally settles after several days, providing the skin is protected from further sun exposure. In a few, the rash may develop a rash after relatively short periods outdoors during the spring and summer.

Sun protective measures are usually adequate, i.e. avoiding prolonged periods outdoors, wearing covering clothing, and applying broad-spectrum sunscreens to exposed skin frequently. Severely affected individuals should be referred to a dermatologist. The following prophylactic treatments may help: systemic steroids, hydroxychloroquine, UVB and photochemotherapy (PUVA).

Moderately potent topical steroids applied twice daily reduce the severity of the reaction. Cooling emollients provide symptomatic benefit. The affected areas should be protected from further sun exposure for several days.

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