Welcome to Dermatology

Stumpers!

Produced by Robyn Latessa, MD

DermatologyToday we’ll be playing

StumpersBaby, Oh

BabyBread & Butter

Sunny Days

Am I Serious?

Prom Night Disasters

Dermatology

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StumpersBaby, Oh

BabyBread and

ButterSunny Days

Am I Serious?

Prom Night Disasters

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

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

Child with slight fever and headache

• Type here

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

Child with painful blisters and oral lesions

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

• Type here

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

Child with this rash, abdominal pain, and

arthralgias

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

A 2 200

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)

A 2 400

Seborrheic keratosis

• “Stuck on” appearance

• Rarely occurs before age 30

• Differential dx---lentigo maligna & lentigo maligna melanoma

• Treatment---leave alone, cryosurgery, or electrocautery

A 2 600

• Type here

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

• Type here

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

Name 3 possibilities for differential diagnosis of this rash

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

A 3 200

• Type here

Melanoma• Know ABCDEs

• Differential dx---nevi, melanoma in situ, lentigo maligna, pigmented basal cell cancer

• Treatment---to dermatologist!

A 3 400

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)

The most common type of skin cancer

Basal cell carcinoma

The in-situ form of this cancer is

also called Bowen’s disease

Squamous cell carcinoma

Two classes of antibiotics that cause

drug-induced photosensitivity

Tetracyclines, fluoroquinolones,

sulfonamides• Reactions generally resemble an

exaggerated sunburn

• In severe cases, may have blister formation

The most severe of the rickettsial fevers, characterized by

sudden onset of fever, headache, myalgias, & characteristic exanthem

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

Immunocompromised patient with

30 lb weight loss

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

Doubler!

Do You Feel Lucky?

Make a Doubler bet!

Doubler

Initially began as drug reaction, now systemic with mucous

membrane involvement

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

2 possible diagnoses for this 52 y/o with painless

spontaneous blister lesions

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

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

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

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

Pruritic rash; other family members have also

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)

18y/o female presents with sudden hair loss in oval patch

on scalp

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

24 y.o. male severe L heel pain, rash, weight loss

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

Surgical emergency, usually caused by Group A Streptococcus

Doubler #1 and the topic is:

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

The Grand Finale• Each side make a bet.

This is your last wager of the game, so make it a thoughtful one.

Caused by bacterial agent

Cutaneous anthrax

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