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LUMPSRefer same week the patient with a lump that:• Bleeds easily• Is a new or changed mole• If the diagnosis is uncertain to exclude skin cancerRaised nodules or papulesSmall, skin-coloured bumpswith pearly central dimplesPurple lumps on skin or in mouthSmall, firm lump beneath the skin,may discharge white materialRed papules, pustules andblackheads on face andperhapson upperback,arms,buttocksand chestWarts likely• Common on hands in youngadults.• Plantar warts on the soles ofthe feet are thick and hardwith a black central point.• Reassure patient thatwarts often disappearspontaneously.• Apply podophyllin resin20% and salicylic acid 25%ointment under a plaster atnight.• Protect surrounding skinwith petroleum jelly.• Refer if warts are extensive.Molluscum contagiosum likely• May be extensive in HIV.• If status is unknown test forHIV 60.• Reassurance (may disappearquickly with ART).• If distressing to patient, trylocal destructive treatment(open molluscum with sterileblade/needle and paint withtincture of iodine).• Refer if no response to ART orlocal destructive treatment.Kaposi’s sarcoma likely• These can vary from isolatedlumps to florid tumours.• If status is unknown test forHIV 60.• This is an AIDS-definingillness.• Patient needs routine HIV careand ART 61.Epidermal cyst likely• If not infected no treatmentneeded.• If warm, tender and red, thecyst is infected:--Incise and drain if largeor fluctuant. Refer if onface or perianal region.--If enlarged lymph nodesor temperature ≥ 38ºCgive flucloxacillin 500mg6 hourly for 5 days. Ifpenicillin allergic giveerythromycin 500mg6 hourly for 5 days.• Refer if large, symptomatic,recurrent infection ordiagnosis uncertain.Acne likely• Steroids, anticonvulsants,isoniazid can all worsen acne.• Advise to avoid squeezinglesions and greasy cosmetics.Diet will not affect acne.• Apply benzoyl peroxide 5%gel at night to inflamedpustules and discuss withdoctor to give doxycycline100mg daily for at least 3months. Doxycycline interfereswith oral contraceptive. Adviseto use condoms as well.• If woman needscontraception, adviseoestrogen-containing oralcontraceptive 91.• Response to treatment isusually slow.• Refer if severe or notresponding to treatment.44TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH