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Welcome to Dermatology Stumpers! Produced by Robyn Latessa, MD Dermatology Today we’ll be playing Stumpers Baby, Oh Baby Bread & Butter Prom Night Disasters Sunny Days Am I Serious? Dermatology Stumpers Baby, Oh Baby Bread and Butter Sunny Days Am I Serious? Prom Night Disasters

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welcome to dermatology stumpers

Welcome to Dermatology Stumpers!

Produced by Robyn Latessa, MD

dermatology
Dermatology

Today we’ll be playing

Stumpers

Baby, Oh Baby

Bread & Butter

Prom Night Disasters

Sunny Days

Am I Serious?

dermatology5
Dermatology

Stumpers

Baby, Oh Baby

Bread and Butter

Sunny Days

Am I Serious?

Prom Night Disasters

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varicella zoster
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
erythema infectiosum fifth s disease
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
hand foot and mouth disease
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
kawasaki s disease
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
henoch sch nlein purpura
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
eczema atopic dermatitis
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)

seborrheic keratosis
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
A 2 600
  • Type here
herpes zoster
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
tinea corporis
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
pityriasis rosea
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
A 3 200
  • Type here
melanoma
Melanoma
  • Know ABCDEs
  • Differential dx---nevi, melanoma in situ, lentigo maligna, pigmented basal cell cancer
  • Treatment---to dermatologist!
actinic keratosis
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)
tetracyclines fluoroquinolones sulfonamides
Tetracyclines, fluoroquinolones, sulfonamides
  • Reactions generally resemble an exaggerated sunburn
  • In severe cases, may have blister formation
slide36
The most severe of the rickettsial fevers, characterized by sudden onset of fever, headache, myalgias, & characteristic exanthem
rocky mountain spotted fever
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
kaposi s sarcoma
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

Doubler

Do You Feel Lucky?

Make a Doubler bet!

Doubler!
stevens johnson syndrome
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
pemphigus vulgaris and bullous pemphigoid
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
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
acne rosacea
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
scabies
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)
alopecia areata
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
reiter s syndrome reactive arthritis
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
necrotizing fasciitis
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
The Grand Finale
  • Each side make a bet. This is your last wager of the game, so make it a thoughtful one.
thank you for playing stumpers
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