Dermatology

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Dermatology

  1. 1. Welcome to Dermatology Stumpers! Produced by Robyn Latessa, MD
  2. 2. Dermatology Today we’ll be playing Stumpers Baby, Oh Baby Bread & Butter Sunny Days Am I Serious? Prom Night Disasters
  3. 3. Dermatology 200 400 600 800 1000 200 400 600 800 1000 200 400 600 800 1000 200 400 600 800 1000 200 400 600 800 1000 Stumpers Baby, Oh Baby Bread and Butter Sunny Days Am I Serious? Prom Night Disasters
  4. 4. 5 y.o. with pruritic rash and mild constitutional symptoms
  5. 5. Varicella zoster • Incubation period of 14 days (10-23) • Contagious several days before rash and until last crop of vesicles • Complications of pneumonia & encephalitis • Differential dx---disseminated HSV, eczema herpeticum, bullous form of impetigo • Symptomatic treatment---oatmeal baths, antihistamines
  6. 6. Child with slight fever and headache • Type here
  7. 7. Erythema infectiosum (Fifth’s disease) • Human parvovirus B19 • Prodrome of fever, malaise, headache, coryza 2 days prior to rash • “Slapped cheeks” usually absent in adults • Differential dx---rubella, measles, scarlet fever, drug reaction • Treatment---symptomatic
  8. 8. Child with painful blisters and oral lesions
  9. 9. Hand-foot-and-mouth disease • Coxsackie virus A16 • Usually self-limited 7-10 days • Differential dx---A sudden outbreak of oral and distal extremity lesions is pathognomonic for HFMD • Treatment---symptomatic
  10. 10. • Type here
  11. 11. Kawasaki’s Disease • Unknown etiology • Fever > 5 days + 4 of below criteria: – Polymorphous rash, bilateral conjunctivitis, cervical LAD, mucous membrane changes, extremity involvement • 80% patients < 5 yrs old • Differential dx---JRA, mono, viral exanthem, RMSF, scalded-skin, erythema multiforme, SLE, Reiter’s syndrome... • Treatment---acetylsalicylic acid & IVIG
  12. 12. Child with this rash, abdominal pain, and arthralgias
  13. 13. Henoch-Schönlein Purpura • IgA mediated, nonthrombocytopenic small vessel vasculitis • Triad of palpable purpuric rash, abdominal pain and/or renal involvement, arthritis • Often post URI • Differential dx---TPP, exanthem, DIC, septic vasculitis, meningococcemia • Treatment---supportive
  14. 14. A 2 200
  15. 15. Eczema (atopic dermatitis) • Onset in 1st 2 months of life, by 1st year in 60 % of patients • Over 2/3 have personal or family history of allergic rhinitis, hay fever, or asthma • Differential dx---seborrheic dermatitis, contact dermatitis, psoriasis, early mycosis fungoides • Treatment---oatmeal baths, topical steroids, oral antihistamines, tacrilimus (Protopic), pimecromilus (Elidel)
  16. 16. A 2 400
  17. 17. Seborrheic keratosis • “Stuck on” appearance • Rarely occurs before age 30 • Differential dx---lentigo maligna & lentigo maligna melanoma • Treatment---leave alone, cryosurgery, or electrocautery
  18. 18. A 2 600 • Type here
  19. 19. Herpes zoster • Acute dermatomal infection associated with reactivation of varicella zoster virus • Neuritic pain precedes rash by 3-5 days • Always consult in ophthalmic zoster • Differential dx---contact dermatitis, bullous impetigo, necrotizing fasciitis • Treatment--- antivirals within 72 hours, ? prednisone, tricyclic antidepressants, Neurontin, lidocaine patch
  20. 20. • Type here
  21. 21. Tinea corporis • Transmission from other parts of the body (tinea pedis & tinea capitis) • Can also be acquired form an active lesion of an animal • Differential dx---contact dermatitis, atopic dermatitis, psoriasis, pityriasis rosea, granuloma annulare • Treatment---various anti-fungal agents
  22. 22. Name 3 possibilities for differential diagnosis of this rash
  23. 23. Pityriasis rosea • Primary or “herald” plaque • Generalized secondary eruption in 1-2 weeks • “Christmas tree” distribution • Usually remits spontaneously in 6-12 weeks • Differential dx---drug eruptions, secondary syphilis, guttate psoriasis, erythema migrans • Treatment---UVB phototherapy, symptomatic
  24. 24. A 3 200 • Type here
  25. 25. Melanoma • Know ABCDEs • Differential dx---nevi, melanoma in situ, lentigo maligna, pigmented basal cell cancer • Treatment---to dermatologist!
  26. 26. A 3 400
  27. 27. Actinic keratosis • Often found on face, neck, forearms, & hands • Estimated 1 SCC developing annually in each 1000 solar keratoses • Differential dx---xeroderma pigmentosum • Treatment---5-FU cream and/or liquid nitrogen, Levulan Kerastick, diclofenac gel (Solaraze), imiquimod (Aldara)
  28. 28. The most common type of skin cancer
  29. 29. Basal cell carcinoma
  30. 30. The in-situ form of this cancer is also called Bowen’s disease
  31. 31. Squamous cell carcinoma
  32. 32. Two classes of antibiotics that cause drug-induced photosensitivity
  33. 33. Tetracyclines, fluoroquinolones, sulfonamides • Reactions generally resemble an exaggerated sunburn • In severe cases, may have blister formation
  34. 34. The most severe of the rickettsial fevers, characterized by sudden onset of fever, headache, myalgias, & characteristic exanthem
  35. 35. Rocky Mountain Spotted Fever • Associated with tick bite (only 60% of people aware of tick bite) • Mortality---untreated 23% • Differential dx---meningococcemia, disseminated gonococcal infection, secondary syphilis, toxic shock syndrome, erlichioisis, viral exanthem, ITP, TTP, Kawasaki’s syndrome • Treatment---doxycycline, tetracycline
  36. 36. Immunocompromised patient with 30 lb weight loss
  37. 37. Kaposi’s Sarcoma • A cancer of the blood vessels • Common with HIV infection and immunosuppression • Differential dx---pyogenic granuloma, hemangioma, melanocytic nevus, granuloma annulare • Treatment---radiotherapy, cryosurgery, laser surgery, intralesional chemotherapy
  38. 38. Doubler! Do You Feel Lucky? Make a Doubler bet! Doubler
  39. 39. Initially began as drug reaction, now systemic with mucous membrane involvement
  40. 40. Stevens-Johnson syndrome • Mucosal lesions – lips & buccal mucosa – conjunctiva – genital & anal • Etiology usually infection or drug reaction • Mortality up to 10% • Differential dx---drug eruptions, erythema multiforme major, scarlet fever, toxic shock syndrome, graft-versus-host disease • Treatment---supportive
  41. 41. 2 possible diagnoses for this 52 y/o with painless spontaneous blister lesions
  42. 42. Pemphigus Vulgaris and Bullous Pemphigoid • Both autoimmune disorders that present as bullous eruption with mucous membrane involvement • Histopathology and immunology needed for accurate diagnosis • Treatment---corticosteroids, immunosupressive agents
  43. 43. Acne vulgaris • Characterized by comedones: open and closed; papules & pustules • Differential dx---folliculitis, pseudofolliculitis barbae, rosacea • Treatment---topical antibiotics, benzoyl peroxide gels, Retin A, oral antibiotics, Accutane
  44. 44. Adult female w/ 3 month hx of facial rash, associated with flushing
  45. 45. Acne Rosacea • Facial rash in middle aged men/women • Cause is unknown: “adult Acne” • Differential dx---acne, perioral dermatitis, folliculitis, SLE • Treatment---metronidazole gel, topical antibiotics, oral tetracycline, minocycline, or doxycycline
  46. 46. Pruritic rash; other family members have also
  47. 47. Scabies • Caused by a little mite that burrows under the skin • Acquired by skin to skin contact • Differential dx---drug reaction, atopic dermatitis, contact dermatitis, eczema, pityriasis... • Treatment---Permethrin (Elimite); Crotamiton (Eurax)
  48. 48. 18y/o female presents with sudden hair loss in oval patch on scalp
  49. 49. Alopecia Areata • Cause is a mystery • Three stages: – sudden hair loss – enlargement of patches – new hair growth (may take months or years) • Differential dx---secondary syphilis, tinea capitis, trichotillomania, cutaneous lupus, androgenetic alopecia • Treatment---local injection of corticosteroids may help
  50. 50. 24 y.o. male severe L heel pain, rash, weight loss
  51. 51. Reiter’s Syndrome (Reactive Arthritis) • Most common inflammatory polyarthritis in young men • 2-4wks post STD or GI • Classic triad of urethritis, conjunctivitis, arthritis • Differential dx---psoriasis, disseminating gonococcal infection, SLE, ankylosing spondylitis, RA, gout • Treatment---topical corticosteroids, NSAIDs, methotrexate
  52. 52. Surgical emergency, usually caused by Group A Streptococcus Doubler #1 and the topic is:
  53. 53. Necrotizing fasciitis • Rapid progression to dusky blue discoloration +/- hemorrhagic bullae • Mortality rate up to 50% • Differential dx---cellulitis, bullous pemphigoid, pemphigus vulgaris • Treatment---requires aggressive debridement
  54. 54. The Grand Finale • Each side make a bet. This is your last wager of the game, so make it a thoughtful one.
  55. 55. Caused by bacterial agent
  56. 56. Cutaneous anthrax
  57. 57. Thank you for playing Stumpers. • This game board was made from a template created at the Mountain Area Health Education Center in Asheville North Carolina as part of its Family Medicine Residency program. Feel free to adapt it but please cite MAHEC Stumpers. • http://www.mahec.net/stumpers

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