This week I was busy with my MOH interview. Hence I dont have any nice case to post. So I thought I will write about how I missed a classical SCLE case in Glasgow for my Dip Derm exam in October 2005.
The mcq exam was on Oct 5 in Glasgow and it was OK for me. I went for the exam with my wife and it was a sort of vacation trip for us. The clinical exam was in Edinburgh on Oct 6.
4 clinical cases were there and the first three went on well. Hence I was partly relaxed when I went for the final case. The fourth patient was a middle aged lady with annular lesions over the upper back and chest. They asked me to take the history. The differentials I had in mind at that moment were disseminated granuloma annulare and extensive tinea corporis. When I started giving my diagnosis I could see that my examiners were not at all impressed. Then finally they asked me to describe the lesions. I started – Annular lesions with minimal itching over covered areas of chest and back. I saw a peculiar expression on my examiners face. One examiner asked me. In your country these are covered areas? Suddenly I knew what I was dealing with and I understood why they were not happy with my history taking. I used to elicit good history from lupus patients during my post graduate days which my professor used to appreciate. Unfortunately I could not use the same skills in this exam.
Though not an excuse for missing such a classical case of SCLE, I think the question of exposed areas is still pertinent. Indian females usually clad in a six meter long fabric called saree. Because of the peculiar way of wearing this outfit the exposed areas in a typical south Indian female are neck and left flank and not chest and upper back.
Incidentally I have published an article on dermatosis in Indian females wearing saree.
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This was interesting. I hope you did well in the rest of the examination. As you have gone through the exam, which book would you recommend for the dderm exam of rcpsg.
can you elaborate on saree induced dermatosis in Indian females?
as a Indian dematologist I may be coming across such patients and missing something
Saree induced dermatosis are rare but, tinea around saree line(waist) , leukoderma caused by pressure over the waist line, inframammary tinea, clothing dermatitis due to the fabric dye and polymorphic light eruptions over the midriff and upper back can be seen.