Welcome to Dermatology Stumpers!

2. Welcome to Dermatology Stumpers! Produced by Robyn Latessa, MD

3. Dermatology Today we’ll be playing Stumpers Baby, Oh Baby Bread & Butter Prom Night Disasters Sunny Days Am I Serious?

5. Dermatology Stumpers Baby, Oh Baby Bread and Butter Sunny Days Am I Serious? Prom Night Disasters 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

6. 5 y.o. with pruritic rash and mild constitutional symptoms

7. 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

8. Child with slight fever and headache • Type here

9. Erythemainfectiosum (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

10. Child with painful blisters and oral lesions

11. 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

12. Type here

13. 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

14. Child with this rash, abdominal pain, and arthralgias

15. Henoch-SchönleinPurpura • 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

16. A 2 200

17. 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)

18. A 2 400

19. Seborrheic keratosis • “Stuck on” appearance • Rarely occurs before age 30 • Differential dx---lentigo maligna & lentigo maligna melanoma • Treatment---leave alone, cryosurgery, or electrocautery

20. A 2 600 • Type here

21. 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

22. Type here

23. 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

24. Name 3 possibilities for differential diagnosis of this rash

25. 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

26. A 3 200 • Type here

27. Melanoma • Know ABCDEs • Differential dx---nevi, melanoma in situ, lentigo maligna, pigmented basal cell cancer • Treatment---to dermatologist!

28. A 3 400

29. 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)

30. The most common type of skin cancer

31. Basal cell carcinoma

32. The in-situ form of this cancer is also called Bowen’s disease

33. Squamous cell carcinoma

34. Two classes of antibiotics that cause drug-induced photosensitivity

35. Tetracyclines, fluoroquinolones, sulfonamides • Reactions generally resemble an exaggerated sunburn • In severe cases, may have blister formation

36. The most severe of the rickettsial fevers, characterized by sudden onset of fever, headache, myalgias, & characteristic exanthem

37. 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

38. Immunocompromised patient with 30 lb weight loss

39. 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

40. Doubler Do You Feel Lucky? Make a Doubler bet! Doubler!

41. Initially began as drug reaction, now systemic with mucous membrane involvement

42. 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

43. 2 possible diagnoses for this 52 y/o with painless spontaneous blister lesions

44. 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

46. 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

47. Adult female w/ 3 month hx of facial rash, associated with flushing

48. 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

49. Pruritic rash; other family members have also

50. 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)