Transcript Dermatology Board Review

 Description
 Flat-topped, polygonal, violaceous papules and plaques
 Wickham’s striae: fine lacy pattern
 Dorsal surface of extremities
 Koebner phenomenon at sites of trauma
 Nail dystrophy
 Oral mucosa: lacy white plaques
 Treatment
 Topical steroids
 Course
 Prolonged period of
hyperpigmentation can be
expected
 Description
 Flat-topped papules appear abruptly
 Erythematous or hypopigmented
 Surfaces with fine scale
 Linear or swirled distribution
 (along skin lines of Blaschko)
 Nail dystrophy
 Location
 Extremeties, neck, upper back
 Timing
 Peak in school-age children
 Course
 Spontaneous resolution 1-2yrs
 Tells you that it’s a viral
lesion
 Multinucleated giant cell
 Not specific to type of virus
 Outdated
 Use DFA, PCR, or Viral
culture
 Superficial bacterial skin
infection
 Cause: GAS, GBS, S.aureus
 Location
 Tips of pads of fingers/toes
 Description
 Tense blisters, 5-10mm
 Filled with thin, purulent fluid
 Narrow erythematous rim
 Thick crust upon rupture
 Which is true of the condition
pictured?
 A Use of systemic steroids may
improve survival
 B Systemic antibiotics with G+
coverage are the mainstay of
treatment
 C Permanent sequelae may include
visual impairment
 D Nikolsky’s sign is negative
 Description
 Symmetrical, red, tender nodules
 1-5cm
 Location
 Pretibial
 Hypersensitivity reaction,
associated with:
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Strep
Sarcoid
Ulcerative colitis
TB
Other bacterial/fungal infxn
Oral contraceptives and other
meds
 Timing/Course
 >10y/o
 Lasts 2-6wks
 Often recurs
 Description
 Red, tender, slightly elevated
nodules
 Indurated SQ plaques
 Brownish-red or purplish-red hue
 Shins most common site
 Treatment
 Tx underlying cause
 Pain: NSAIDS and rest
 Aka “Hives” “Welts”
 Course
 Sudden onset
 Transient
 Lasts 1-24hrs
 Description
 Well-demarcated intensely pruritic
 Appear to migrate
 May coalesce
 White/red “halo”
 Cause: can be IgE or complement mediated
 Acute (<6wks)
 IgE
 Acute infections (strep, mono)
 Foods
 Drugs
 Insect bites
 Contact or inhaled allergen
 Chronic (>6wks)
 Occult infection
 Hep B
 Connective tissue dz
 This child has mild
edema of hand/feet and
painful migratory
periarticular swelling of
wrists and ankles. The
most likely etiology is:
 A Staph Scalded Skin Syndrome
 B Henoch-Schonlein Purpura
 C Hemolytic Uremic Syndrome
 D Interstitial nephritis as part of a reaction to medications
 E Serum Sickness-Like Reaction
 Type III reaction: Immune-Complex Deposition
 Symptoms
 Urticarial lesions
 Relatively nonpruritic
 Target or serpiginous
 Periarticular swelling
 Migratory
 Stocking-glove angioedema
 Painful
 Facial edema
 Fever
 Triggers
 URI
 Meds
 Sulfa
 Cefaclor
 Minocycline
 PCN
 Course
 Wax and wane over 1-3wks
 Hypersensitivity syndrome
 Causes
 Drugs, viruses, bacteria, foods,
immunizations
 Connective tissue dz
 Recurrent EM
 Recurrent HSV infxn
 Location
 Any part of body
 Commonly: palms/soles, arms/legs
 Description
 Symmetrical
 Dusky red macules – evolve into iris or target-shaped
lesions
 Center of target may be blue, violaceous, or white
 Vescicles or bullae may develop
 Center or ring of target
 May appear as diffuse urticaria initially
 Non-pruritic, may be painful
 Course
 Crops last 1-3 wks
 Self limited
 ?Mild systemic symptoms?
 Low grade fever
 Malaise
 Myalgia
 Mucous membranes spared
 Or mildly involved
 Epidermal and mucous membrane necrosis and
sloughing
 Cleavage beneath basment membrane zone
 Full-thickness sloughing
 SJS: <30% BSA
 TEN: >30% BSA
 Cause: hypersensitivity, viral infxn, connective tissue
dz, malignancy
 Ophtho:
 Corneal scarring
 Lid scarring: ectropion
 FEN
 Dehydration
 Malnutrition
 Electrolyte imbalance
 ID
 Superficial infection
 Sepsis
 Death
 Treatment
 IVIG
 Steroids relatively contraindicated
 GI symptoms
 Immune suppression
 Differentiate from SSSS
 SSSS
 Bullae more thin-walled
 Mucous membranes red, but do not slough
 75% of all cutaneous drug reactions
 Description
 Erythematous macules and papules
 Range from fine to blotchy
 Eruption 5-14days after starting med
 Face/Trunk  extremities
 May become confluent
 Resolves over 1-2 wks
 May see mild purpura, desquamation
 Recur at same localized site following reexposure to
offending drug
 Target and bullous lesions
 Resemble erythema multiforme
 Morphologically and histologically
 (only localized)
 Classic Tetrad
 Palpable purpura
 Without thrombocytopenia or coagulopathy
 Present in almost all patients
 Arthritis/Arthralgia
 75%
 Abdominal Pain (May have hematochezia)
 50%
 Intussussception (ileo-ileal)
 Renal Disease (Mild)
 21-54%
 Not all symptoms must be present for diagnosis
 Takes days to weeks to develop
 May present as abd pain or joint complaints*
 May recur
 Diffuse Vasculitis
 Histo:
 immune-complex deposition in capillaries
 Leukocytic vasculitis in skin
 Treatment
 Supportive
 May use steroids if severe
 DIFFERENTIATE FROM HUS
 Hemolytic Uremic Syndrome
 More toxic
 Renal involvement more severe (dialysis)
 Hemolytic: anemia, thrombocytopenia
 More severe neuro manifestations