Stumpers XP template

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Welcome to Dermatology Stumpers!

• Produced by Robyn Latessa, MD

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Dermatology
Today well be playing
Stumpers
Baby, Oh Baby
Bread Butter
Prom Night Disasters
Sunny Days
Am I Serious?
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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
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5 y.o. with pruritic rash and mild constitutional
symptoms
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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

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Child with slight fever and headache

• Type here

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Erythema infectiosum (Fifths 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

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Child with painful blisters and oral lesions
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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

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• Type here

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Kawasakis Disease

• Unknown etiology
• Fever 5 days 4 of below criteria
• Polymorphous rash, bilateral conjunctivitis,
  cervical LAD, mucous membrane changes, extremity
  involvement
  
• 80 patients
• Differential dx---JRA, mono, viral exanthem,
  RMSF, scalded-skin, erythema multiforme, SLE,
  Reiters syndrome...
  
• Treatment---acetylsalicylic acid IVIG

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Child with this rash, abdominal pain, and
arthralgias
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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

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A 2 200
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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)

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A 2 400
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Seborrheic keratosis

• Stuck on appearance
• Rarely occurs before age 30
• Differential dx---lentigo maligna lentigo
  maligna melanoma
  
• Treatment---leave alone, cryosurgery, or
  electrocautery
  

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A 2 600

• Type here

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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

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• Type here

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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

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Name 3 possibilities for differential diagnosis
of this rash
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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

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A 3 200

• Type here

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Melanoma

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

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A 3 400
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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)
  

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The most common type of skin cancer
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Basal cell carcinoma
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• The in-situ form of this cancer is also called
  Bowens disease

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Squamous cell carcinoma
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Two classes of antibiotics that cause
drug-induced photosensitivity
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Tetracyclines, fluoroquinolones, sulfonamides

• Reactions generally resemble an exaggerated
  sunburn
  
• In severe cases, may have blister formation

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The most severe of the rickettsial fevers,
characterized by sudden onset of fever,
headache, myalgias, characteristic exanthem
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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, Kawasakis syndrome
• Treatment---doxycycline, tetracycline

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Immunocompromised patient with 30 lb weight loss
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Kaposis 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
  

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Doubler!
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Initially began as drug reaction, now systemic
with mucous membrane involvement
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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

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

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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

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

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Pruritic rash other family members have also
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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)

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

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

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Surgical emergency, usually caused by Group A
Streptococcus
Doubler 1 and the topic is
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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

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The Grand Finale

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

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Caused by bacterial agent
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Cutaneous anthrax
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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