dermatology cases – Flashcards
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Atopic dermatitis (eczema)
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Adolescent with asthma presents with: long standing intermittent, pruritic, papulosquamous eruption over antecubital fossa, behind knees; worse after hot showers
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Seborrheic dermatitis Can also present on eyebrows, lashes, facial hair HIV can have a much worse presentation; Due to a lipophilic yeast in skin called Pityrosporum ovale and can be tx with ketoconazole cream, ciclopirox gel or low potency topical steroid.
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Adult pt with: "dandruff" and scaly rash around the nose with underlying redness when the scales are removed
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Contact dermatitis Common triggers: plants (poison ivy, oak), nickle, perfumes, rubber, synthetic shoe materials
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Pt develops: Itchy, papulosquamous rash on abdomen- scaly, well circumscribed lesion at the area of the belt buckle
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Rosacea Keys: lack of comedones, worse with alcohol, telangiectasias
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Middle-aged female develops: "Acne" on the cheeks Repeated eruptions of facial flushing and erythematous papular lesions, made worse with alcohol intake Multiple small papules on the cheeks without comedones Scattered telangiectasias
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Hidradentis suppurativa DDx- boils (furuncles, not symmetric, get central necrosis), acne conglobata (not in axilla)
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Female presents with: Pain under both axilla x 2 mo- began as small bumps but getting larger Significant pain and erythema around the bumps x 24 hrs Deep, nodular lesions in both axilla without any cental area of necrosis Few comedones in the axilla
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Hairy Leukoplakia Caused by EBV DDx- thrush- whole mouth, can be removed with red undersurface
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Pt with: Wt. loss x 3 mo Intermittent fevers Bilateral white plaques on the lateral aspect of the tongue that cannot be removed with a tongue depressor + HIV ELISA, Western Blot
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Geographic tongue-yellowish or looks like patchs of "missing tongue"; Only tongue condition that is migratory (changes position)
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Pt with:Intermittent mild pain and burning on the tongue Variable, raised, yellow pattern on the tongue that changes position
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Fixed drug eruption Same rash every time Frequently in the genital region
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Pt prescribed Doxycycline for rx of pneumonia, after 3 days develops: Large erythematous annular plaque in the genital region Had same rash as teen when given Doxy for acne Resolves with DC of Abx
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Psoriasis Assc with spondyloarthropathies
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20's y/o with: Bilateral itchy, erythematous plaques in knees, elbows that develop an adherant silvery scale that bleeds when removed Similar plaques on the scalp multiple tiny pits in some of the nail beds
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Erythema nodosum Bilateral painful nodules over shins= E. nodosum! Assc. with GAS pharyngitis, Coccidiodes, Histoplasmosis, TB, sarcoidosis (with hilar adenopathy), IBD (with abd pain) 75% idiopathic
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Previously healthy female with: Fever Sore throat 3 wks painful, erythematous nodules on shins-> bruises
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Pyoderma gangrenosum Keys: UC, neutrophilic infiltrate; Assoc with IBD (crohn's and UC); May also be assoc with RA. Usually has a violaceous hue.
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Pt with active ulcerative colitis presents with: Pretibial sore, began as erythematous pustule->nodular->ulcer, ragged with purple raised border Skin bx- tissue necrosis with neutrophilic infiltrate cx- Staph, but no AFB or fungi
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Verrucus vulgaris (plantar warts) Keys: wt bearing parts of feet, verrucous appearance, disruption of nl skin lines
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Pt with: Pain with walking Multiple raised verrucous growths on the heels and balls of the feet that obscure the nl skin markings and are painful when palpated
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Condyloma accuminata Confused with condyloma lata of syphilis (flat, wet, not verrucous)
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Sexually active pt with: multiple painless, cauliflower-like, verrucous lesions on the external genitalia
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Molluscum contagiosum Key- central umbilication Have depressed center to the lesions Can be large, numerous with HIV
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Pt with: Multiple, painless clustered papules with central umbilication on the arm (or anywhere else)
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Tinea capitis Keys: elderly, African American, barber, black dots. Usually an unclean razor
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African American male, complains of hair loss after getting his hair cut by an electric razor Annular scaly patch of hair loss Small black dots over the hair follicles Palpable small posterior cervical lymph nodes
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Tinea corporis Clues: cat. Could be wrestler. Often confused with herald patch of pityriasis, but that doesn't itch. Granuloma annulare doesn't scale. Nummular eczema looks different on micro
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Pt with: annular scaly rash on arm, present since week after getting a new cat Clear towards center of rash with raised advancing erythematous margin and scale
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Tinea pedis Can also see vesicles, nail thickening
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Pt wears heavy shoes and goes to then gym with: Itchy rash between toes Multiple intensely pruritic pinpoint vesicles between the toes
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Tinea versicolor Patches tend to be worse in the summer Disseminated skin rashes can be syphilis, micro gives diagnosis From malassezia furfur; very difficult to tx.
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Dark skinned individual presents with: Scaly rash on chest Numerous hypo and hyper pigmented areas No large isolated patch No itching KOH stain- spaghetti and meatball fungal hyphae
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Pediculosis capitus= head lice Might see nits, louse picture
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Adolescent from a group home with: Scalp itching Erythema at the base of the scalp Mild bilateral posterior auricular lymphadenopathy Woods lamp- small area of pale blue fluorescence at the base of multiple hair shafts
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Pediculosis pubis = pubic lice Blue macules not always present Can be visible Ddx scabies- see itching in other parts of the body as well
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Young sexually active adult with: Itching in pubic region Multiple small bluish macules along the upper abdomen and inner thighs Palpable small inguinal lymph node
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Scabies May describe mite burrow Intense itching, ESP axillary and interdigital webs
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Nursing home pt with: Itching, worse at night, x1 month Multiple excoriations in both axilla and groin, on the wrists, between fingers
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Basal cell CA Key: pearly papules. May ulcerate
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Middle aged Caucasian woman with: Skin lesion on forehead HO extensive sun exposure as child with repeated sunburns Flesh colored papular lesion with pearly sheen, multiple telangiectasias
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Multiple actinic keratosis with squamous cell CA in situ AKs turn into SCC
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Middle aged Caucasian woman with: Skin lesion on forehead HO extensive sun exposure as child with ,multiple sunburns Multiple rough scaly patches on forehead, dorsum of hands One patch on the forehead has a firm hyperkeratotic macule
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Melanoma Remember the ABCDEs
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Middle aged Caucasian woman with Skin lesion on her thigh HO extensive sun exposure as a child with repeated sunburns Flat, asymmetric, pigmented lesion, lacks uniform color, is 8mm in size Enlargement over the last few months
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Porphyria cutanea tarda Always think of with Hep C, isolated rash on hands Urine uroporprin levels just confirm it Can be scaly, blistering, vesicles
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Pt with Hep C, cirrhosis with: Blistering lesions on dorsum of hands, began as erythematous macules with adherent scale Intermittent sun exposure in past month Elevated urine uroporphyrin levels
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Bullous pemphigoid Usually biopsy Increasing in frequency Onset middle ages, pruritic bullae, improves with steroids Ddx- dermatitis herpetiformis- not restricted to flexural areas, presents with assc disease like celiac dz
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Middle aged male, itchy recurrent skin rash Pruritic papulosquamous lesions in axilla, progress to vesicles and bulla Vesicles burst, giving erosions Lesions not symmetric, don't always occur in the same place Normal mucosal surfaces Improved with potent topical corticosteroids
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Erythema multiforme with genital HSV Usually assc with new HSV infection, can also see with mycoplasma infection
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Sexually active adult with: Pain in the genital region Rash on forearm Multiple small painful blisters on external genitalia with surrounding erythema Several small target shaped lesions on forearm without scale or itch No mucosal lesions
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30%= toxic epidermal necrolysis" alt="Stevens-Johnson syndrome Triggers: sulfas, abxs, allopurinol, antiepileptics (esp phenytoin, carbamazapine), NSAIDs Skin sloughing of >30%= toxic epidermal necrolysis">
Stevens-Johnson syndrome Triggers: sulfas, abxs, allopurinol, antiepileptics (esp phenytoin, carbamazapine), NSAIDs Skin sloughing of >30%= toxic epidermal necrolysis
30%= toxic epidermal necrolysis" alt="Stevens-Johnson syndrome Triggers: sulfas, abxs, allopurinol, antiepileptics (esp phenytoin, carbamazapine), NSAIDs Skin sloughing of >30%= toxic epidermal necrolysis">answer
Pt with HIV: prescribed Bactrim for presumed pneumocystis infection 2 days later, gets fever, painful erythematous blistering rash on <10% of body surface, including mucous membranes, mouth, and conjunctiva
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Pityriasis rosea
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Young patient with: Asymtomatic rash on back 1 wk after circular salmon-colored scaly patch on chest Multiple plaques on back with long axis oriented in direction of skin lines in "christmas tree" distribution; No tx necessary and usually clears within 6-8 wks.
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Acanthosis nigricans Can see with DM, new GI or lung malignancies that are aggressive and quickly spreading
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Obese pt with: Polyuria Velvety pigmented rash in folds of neck and axilla Fasting glucose >125
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Necrobiosis lipoidica diabeticorum Painful nodules would be E. Nodosa. These are yellow plaques
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Diabetic pt with: Yellowish irregular plaques with purplish pigment at the edges over both shins
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This is seborrheic keratoses and it may be a marker for a non-skin malignancy but is completely benign and not a precancerous lesion. Usually has "stuck on" appearance (like you stuck on a piece of clay) with warty surface.
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What's this and is it a marker for malignancy.
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Guttate psoriasis. Get small, droplike 1-10mm salmon-pink papules with fine scale. Guttate comes fro latin "gutta" which means drop. History of URI may precede eruption, esp due to strep;
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22 y/o woman presents with hundreds of 2-5 mm scaly red papules on trunk and extremities that are moderately pruritic. Lesions appeared abruptly about 2 wks prior to exam and quickly spread. Pt had sore throat the prior month. What's dx?
