Friday, 25 April 2014

Friday, 11 April 2014

Black heel

Black heel (talon noire) lesions or calcaneal petechiae result from lakes of haemorrhage in the stratum corneum. The red blood corpuscles are extravasated into the lower epidermis from dilated vessels in the papillary dermis. They undergo transepidermal elimination in the form of old blood during the progressive maturation of the epidermis and overlying stratum corneum. The condition results from shear–stress rupture of the papillary capillaries in a traumatic process particularly where sudden twisting of the heel occurs. The condition starts as closely aggregated groups of bluish black specks that occur suddenly at the back or side of the heel just above the hyperkeratotic edge of the foot.

Lesions comparable in appearance, pathogenesis, and pathology occur in other situations such as jogger’s toenail, and weeder’s thumb. The term posttraumatic punctate haemorrhage has been proposed as a unifying term.

It may be mistaken for a plantar wart, a tattoo, or even a melanoma (seeming confluence may lead to mimicry of melanoma). But when there is a history of sudden appearance of the pigmented lesions at a typical site, diagnosis is rarely in doubt. Viral warts can also produce a black stippled appearance because of extravasation of red blood corpuscles, but the skin surface is generally abnormal. Occasionally, melanoma or atypical melanocytic hyperplasia will need to be excluded. With black heel, the patient and the skin physician can usually be reassured by carefully paring the affected area, thereby completely removing the abnormality. Dermatoscopy shows “globules on ridges”.

Treatment is unnecessary.

This page was last updated in April 2014

Saturday, 5 April 2014

Friday Meetings: Friday 2/5/2014

Friday 2/5/14 2:30 pm Cairo Time Google Plus Hangout

One-topic meeting:

An update on the management of acne vulgaris and acneiform eruptions 

Note that isotretinoin is also useful in women who develop acne in the third (20 - 30) or fourth (30 - 40) decades of life, since late onset acne is frequently unresponsive to antibacterials.

Free talks via Google Hangout on Fridays have been arranged. These Friday Meetings have been audiovisual online meetings where we have typed, talked and screen shared. The Handouts, when available, can be emailed on request unless they become out-of-date. 

Similarly, Thursday Meetings have been developed to discuss Rook's Textbook of Dermatology on Google Hangout. 

Wednesday, 2 April 2014

RCPE Streaming to Egypt 2014

*Dermatology Symposium at the Royal College of Physicians of Edinburgh. 

Date: Thursday 15/5/2014

Venue Details
Symposium report

I will be in Doctors' Club in Egypt explaining any vague points after each session to colleagues.

*Leprosy: old disease in a new era at the Royal College of Physicians of Edinburgh. 

Date: Friday 6/6/2014
Venue Details

Discussion will take place inside and outside the conference hall in EMS Giza branch following the leprosy lecture.  

*Congenital adrenal hyperplasia - Male hypogonadism at the Royal College of Physicians of Edinburgh. 

Date: Wednesday 29/10/2014
Web Streaming Egyptian Site Details

I will be in EMS Giza branch explaining any vague points in relation to the two lectures. 

Update (29/10/14): When I arrived at the EMS Giza where the web-streaming was taking place I found an unresolved technical error in the transmission. I was invited to lecture on congenital adrenal hyperplasia and male hypogonadism. I enjoyed the event very much with the interactive audience. 

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology