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DermatologyDermatology
Board Review 2005Board Review 2005
Julia Akaah M.D.Julia Akaah M.D.
Case 1Case 1
 6 month old infant has a 2 month history of6 month old infant has a 2 month history of
erythematous erosion...
Acrodermatitis enteropathicaAcrodermatitis enteropathica
 AR disorder associated with defective transportAR disorder associated with defective transport
protein in the GI tract, ...
Case 2Case 2
You are asked to evaluate a boy with dryYou are asked to evaluate a boy with dry
skin. He has history of mild...
Ichthyosis vulgarisIchthyosis vulgaris
 Ichthyosis describes group of inherited andIchthyosis describes group of inherited and
acquired disorders of keratinizat...
Case 3Case 3
 You are asked to evaluate a 1 day oldYou are asked to evaluate a 1 day old
healthy term infant with a rash....
Transient neonatal pustularTransient neonatal pustular
melanosismelanosis
 Condition begins in uteroCondition begins in utero
 At birth there are pustules and 2-3 mmAt birth there are pustules a...
Case 4Case 4
 Your are asked to evaluate a 1 day old fullYour are asked to evaluate a 1 day old full
term, healthy infant...
Erythema ToxicumErythema Toxicum
 Benign, self limited eruption occurs in 50%Benign, self limited eruption occurs in 50%
of term newbornsof term newborns
...
Case 5Case 5
 18 month old boy presents with 2 month18 month old boy presents with 2 month
history of recurring pruritic ...
Papular urticariaPapular urticaria
 Delayed hypersensitivity reaction to stinging orDelayed hypersensitivity reaction to stinging or
biting arthropods (dog ...
Case 6Case 6
 14 yo girl with tuberous sclerosis comes14 yo girl with tuberous sclerosis comes
for evaluation of rash on ...
Adenoma sebaceumAdenoma sebaceum
 These lesions are angiofibromas, benignThese lesions are angiofibromas, benign
tumorstumors
 Appear during childhood or...
Case 7Case 7
 8 year old presents with localized loss of8 year old presents with localized loss of
scalp hair of 2 months...
TrichotillomaniaTrichotillomania
 Alopecia from repetitive twirling, rubbing,Alopecia from repetitive twirling, rubbing,
or plucking of the hairor pluckin...
Case 8Case 8
 Healthy 14 yr old girl is worried about anHealthy 14 yr old girl is worried about an
area of skin thickenin...
Linear sclerodermaLinear scleroderma
 Scleroderma is a C.T. disorder withScleroderma is a C.T. disorder with
autoimmune etiologyautoimmune etiology
 Lesions ...
 Self limited with disease activity lasting 3-5Self limited with disease activity lasting 3-5
yrsyrs
 Morbidity when fac...
Case 9Case 9
 7 year old girl develops widespread linear7 year old girl develops widespread linear
red papules and vesicl...
Rhus dermatitis (poison ivy)Rhus dermatitis (poison ivy)
 Poison ivy is a type IV delayed hypersensitivityPoison ivy is a type IV delayed hypersensitivity
reaction that occurs in...
Case 10Case 10
 40 year old female comes in for evaluation40 year old female comes in for evaluation
of flushing around t...
RosaceaRosacea
 Pustular eruption withPustular eruption with
flushing andflushing and
telangiectasias of thetelangiectasias of the
butte...
 Pustules are recurrent and difficult to healPustules are recurrent and difficult to heal
 Disease is influenced by oily...
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Dermatology Board Review 2005 Julia Akaah M.D.

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Transcript of "Dermatology Board Review 2005 Julia Akaah M.D."

  1. 1. DermatologyDermatology Board Review 2005Board Review 2005 Julia Akaah M.D.Julia Akaah M.D.
  2. 2. Case 1Case 1  6 month old infant has a 2 month history of6 month old infant has a 2 month history of erythematous erosions around the mouth,erythematous erosions around the mouth, hands, feet, and in the perineum. There ishands, feet, and in the perineum. There is crusting of the scalp and hair is sparse.crusting of the scalp and hair is sparse. The infant has experienced diarrhea andThe infant has experienced diarrhea and poor weight gain for the past month. Thepoor weight gain for the past month. The infant was weaned from breast milk toinfant was weaned from breast milk to formula at 2 months of ageformula at 2 months of age
  3. 3. Acrodermatitis enteropathicaAcrodermatitis enteropathica
  4. 4.  AR disorder associated with defective transportAR disorder associated with defective transport protein in the GI tract, resulting in impairedprotein in the GI tract, resulting in impaired absorption of dietary zincabsorption of dietary zinc  Human milk contains a protein that facilitatesHuman milk contains a protein that facilitates xinc absorption therefore symptoms appear afterxinc absorption therefore symptoms appear after infant is weanedinfant is weaned  Zinc deficiency occurs with CF, celiac diseaseZinc deficiency occurs with CF, celiac disease and patients on TPN w/o zincand patients on TPN w/o zinc  Zinc deficiencyZinc deficiency  altered keratin synthesisaltered keratin synthesis  Diagnosis is confirmed by low serum zinc levelsDiagnosis is confirmed by low serum zinc levels  Tx: zinc sulfate 5mg/kg/d with topicalTx: zinc sulfate 5mg/kg/d with topical corticosteroidscorticosteroids
  5. 5. Case 2Case 2 You are asked to evaluate a boy with dryYou are asked to evaluate a boy with dry skin. He has history of mild atopicskin. He has history of mild atopic dermatitis. The boy’s father also has scalydermatitis. The boy’s father also has scaly skin and allergic rhinitis. PE revealsskin and allergic rhinitis. PE reveals generally dry skin and thin scales thatgenerally dry skin and thin scales that have a “pasted on” appearance on thehave a “pasted on” appearance on the extensor surface of the legs and butttocksextensor surface of the legs and butttocks
  6. 6. Ichthyosis vulgarisIchthyosis vulgaris
  7. 7.  Ichthyosis describes group of inherited andIchthyosis describes group of inherited and acquired disorders of keratinization which are allacquired disorders of keratinization which are all associated with scalingassociated with scaling  Ichthyosis vulgaris is most common: AD,Ichthyosis vulgaris is most common: AD, apparent between 3m to 5 yearsapparent between 3m to 5 years  Thin scales with elevated edges, with pasted onThin scales with elevated edges, with pasted on appearance, extensor surfaces of lowerappearance, extensor surfaces of lower extremities, trunk and upper extremities (faceextremities, trunk and upper extremities (face antecubital and popliteal fossa are spared)antecubital and popliteal fossa are spared)  Improves over timeImproves over time  50% of children also have atopic dermatitis50% of children also have atopic dermatitis  Treatment: Keratolytics (lactic a., glycolic a, ureaTreatment: Keratolytics (lactic a., glycolic a, urea based emolliants) and oral retinoids in severebased emolliants) and oral retinoids in severe casescases
  8. 8. Case 3Case 3  You are asked to evaluate a 1 day oldYou are asked to evaluate a 1 day old healthy term infant with a rash. Scatteredhealthy term infant with a rash. Scattered pustules without surrounding erythemapustules without surrounding erythema involving the trunk and forehead andinvolving the trunk and forehead and several small hyperpigmented macules,several small hyperpigmented macules, some of which possess a collarette ofsome of which possess a collarette of scalescale
  9. 9. Transient neonatal pustularTransient neonatal pustular melanosismelanosis
  10. 10.  Condition begins in uteroCondition begins in utero  At birth there are pustules and 2-3 mmAt birth there are pustules and 2-3 mm hyperpigmented maculeshyperpigmented macules  Macules are surrounded by collarette ofMacules are surrounded by collarette of scale that represents remnant of a pustulescale that represents remnant of a pustule roofroof  A gram or Wright stain will reveal PMNsA gram or Wright stain will reveal PMNs without organismswithout organisms  Benign self limited disorderBenign self limited disorder  Diff dx: erythema toxicum, neonatal acne,Diff dx: erythema toxicum, neonatal acne, miliamilia
  11. 11. Case 4Case 4  Your are asked to evaluate a 1 day old fullYour are asked to evaluate a 1 day old full term, healthy infant with a rash. There areterm, healthy infant with a rash. There are erythematous macules and in the center oferythematous macules and in the center of each macule is a solitary papule oreach macule is a solitary papule or occasionally a vesicleoccasionally a vesicle
  12. 12. Erythema ToxicumErythema Toxicum
  13. 13.  Benign, self limited eruption occurs in 50%Benign, self limited eruption occurs in 50% of term newbornsof term newborns  Develop 2-3 cm erythematous maculesDevelop 2-3 cm erythematous macules that have a central papule, pustule orthat have a central papule, pustule or vesiclevesicle  Can involve any body surface area exceptCan involve any body surface area except palms or solespalms or soles  Eruption begins 24-48 hours of life andEruption begins 24-48 hours of life and lasts 4-5 dayslasts 4-5 days  Wright stain of vesicles revealsWright stain of vesicles reveals eosinophilseosinophils  DDx: milia, neonatal acne, and transientDDx: milia, neonatal acne, and transient pustular melanosispustular melanosis
  14. 14. Case 5Case 5  18 month old boy presents with 2 month18 month old boy presents with 2 month history of recurring pruritic eruption.history of recurring pruritic eruption. Outbreaks last 1-2 weeks. No one else inOutbreaks last 1-2 weeks. No one else in the household is similarly affected.the household is similarly affected. Physical exam reveals clusteredPhysical exam reveals clustered erythematous papules 4-6mm in diameter.erythematous papules 4-6mm in diameter. Several papules have a central punctum.Several papules have a central punctum.
  15. 15. Papular urticariaPapular urticaria
  16. 16.  Delayed hypersensitivity reaction to stinging orDelayed hypersensitivity reaction to stinging or biting arthropods (dog or cat fleas, mosquitos,biting arthropods (dog or cat fleas, mosquitos, lice, grass mites etc.)lice, grass mites etc.)  Affected children are 18 months to 7 years andAffected children are 18 months to 7 years and only members of household to have symptomsonly members of household to have symptoms  Each crop of papules last 2-10 days andEach crop of papules last 2-10 days and recurrences may be observed for 3-9 monthsrecurrences may be observed for 3-9 months  Tx: remove the offending agent, topicalTx: remove the offending agent, topical corticosteroid and oral antihistamine if pruritis iscorticosteroid and oral antihistamine if pruritis is severe, apply insect repellent (with DEET) ifsevere, apply insect repellent (with DEET) if outdoor insects are implicatedoutdoor insects are implicated
  17. 17. Case 6Case 6  14 yo girl with tuberous sclerosis comes14 yo girl with tuberous sclerosis comes for evaluation of rash on the face. Thefor evaluation of rash on the face. The only medication she takes is felbamate foronly medication she takes is felbamate for seizures. Examination of face revealsseizures. Examination of face reveals numerous 1-3 mm pink papules in thenumerous 1-3 mm pink papules in the malar areas bilaterallymalar areas bilaterally
  18. 18. Adenoma sebaceumAdenoma sebaceum
  19. 19.  These lesions are angiofibromas, benignThese lesions are angiofibromas, benign tumorstumors  Appear during childhood or adolescenceAppear during childhood or adolescence but occasionally observed at birthbut occasionally observed at birth  These lesions do not involute and mayThese lesions do not involute and may coalesce to form plaquescoalesce to form plaques
  20. 20. Case 7Case 7  8 year old presents with localized loss of8 year old presents with localized loss of scalp hair of 2 months duration. PEscalp hair of 2 months duration. PE reveals patch of alopecia within whichreveals patch of alopecia within which hairs are of differing lengths. Remainderhairs are of differing lengths. Remainder of the scalp is normal with no erythema,of the scalp is normal with no erythema, scaling, or “black dot” hairsscaling, or “black dot” hairs
  21. 21. TrichotillomaniaTrichotillomania
  22. 22.  Alopecia from repetitive twirling, rubbing,Alopecia from repetitive twirling, rubbing, or plucking of the hairor plucking of the hair  Scalp, eyebrows and lashes are affectedScalp, eyebrows and lashes are affected  Often result of habit and stressOften result of habit and stress  Irregularly shaped patch of alopeciaIrregularly shaped patch of alopecia without erythema or scaling containingwithout erythema or scaling containing hairs of differing lengthshairs of differing lengths  Diff Dx: traction alopecia, alopecia areataDiff Dx: traction alopecia, alopecia areata and tinea capitusand tinea capitus
  23. 23. Case 8Case 8  Healthy 14 yr old girl is worried about anHealthy 14 yr old girl is worried about an area of skin thickening, tightness andarea of skin thickening, tightness and discoloration, that developed 3 monthsdiscoloration, that developed 3 months ago. No trauma and no associatedago. No trauma and no associated symptoms. PE shows shinysymptoms. PE shows shiny hypopigmented patch with a brown border,hypopigmented patch with a brown border, skin is immobile and firm and has boundskin is immobile and firm and has bound down feelingdown feeling
  24. 24. Linear sclerodermaLinear scleroderma
  25. 25.  Scleroderma is a C.T. disorder withScleroderma is a C.T. disorder with autoimmune etiologyautoimmune etiology  Lesions begin as an area of indurated skinLesions begin as an area of indurated skin surrounded by a violaceous halo. Oversurrounded by a violaceous halo. Over time the violaceous halo takes on a waxy,time the violaceous halo takes on a waxy, ivory appearance. As the disease remits itivory appearance. As the disease remits it becomes atrophic with hyper andbecomes atrophic with hyper and hypopigmentationhypopigmentation  Linear scleroderma develops in band likeLinear scleroderma develops in band like distribution, unilateral, involve extremities,distribution, unilateral, involve extremities, face and trunkface and trunk
  26. 26.  Self limited with disease activity lasting 3-5Self limited with disease activity lasting 3-5 yrsyrs  Morbidity when face is involved or jointMorbidity when face is involved or joint function is compromisedfunction is compromised
  27. 27. Case 9Case 9  7 year old girl develops widespread linear7 year old girl develops widespread linear red papules and vesicles over her armsred papules and vesicles over her arms and legs. Seven days earlier she hadand legs. Seven days earlier she had been riding her bike in the woods with herbeen riding her bike in the woods with her dog. The rash began 3 days ago and newdog. The rash began 3 days ago and new blisters are continuing to developblisters are continuing to develop
  28. 28. Rhus dermatitis (poison ivy)Rhus dermatitis (poison ivy)
  29. 29.  Poison ivy is a type IV delayed hypersensitivityPoison ivy is a type IV delayed hypersensitivity reaction that occurs in patients with contactreaction that occurs in patients with contact dermatitisdermatitis  Following a period of sensitization of 1-2 wksFollowing a period of sensitization of 1-2 wks predisposed individuals develop a cutaneouspredisposed individuals develop a cutaneous reaction on re-exposure to allergenreaction on re-exposure to allergen  Following exposure to poison ivy, the skin rashFollowing exposure to poison ivy, the skin rash can spread for several dayscan spread for several days  Langerhans cells process the contact allergenLangerhans cells process the contact allergen and vary over the skin surfaceand vary over the skin surface  Reaction subsides over 2-4 weeks if noReaction subsides over 2-4 weeks if no treatment giventreatment given  Tx: cool tap water compresses, topical lotionsTx: cool tap water compresses, topical lotions and steroids and antihistaminesand steroids and antihistamines
  30. 30. Case 10Case 10  40 year old female comes in for evaluation40 year old female comes in for evaluation of flushing around the nose and cheeksof flushing around the nose and cheeks associated with dilated veinsassociated with dilated veins
  31. 31. RosaceaRosacea
  32. 32.  Pustular eruption withPustular eruption with flushing andflushing and telangiectasias of thetelangiectasias of the butterfly area of thebutterfly area of the faceface  Adults 40-60yrs ofAdults 40-60yrs of ageage  Severe longstandingSevere longstanding cases eventuate incases eventuate in the bulbous, greasy,the bulbous, greasy, hypertrophic nosehypertrophic nose characterisitic ofcharacterisitic of rhinophymarhinophyma
  33. 33.  Pustules are recurrent and difficult to healPustules are recurrent and difficult to heal  Disease is influenced by oily skin,Disease is influenced by oily skin, excessive alcohol ingestion, spicy foodsexcessive alcohol ingestion, spicy foods and hot drinks, sun exposure and stressand hot drinks, sun exposure and stress  Tx: avoidance of chocolate, nuts, cheese,Tx: avoidance of chocolate, nuts, cheese, cola, alcohol, spices, seefoodcola, alcohol, spices, seefood  Metronidazole gel, tetracyclineMetronidazole gel, tetracycline
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