Answers To Clinical Application Questions

A 68-year-old retired bank executive seeks your help regarding a progressively disabling and intensely pruritic rash that has generalized over the past 6 months. Examination reveals a widespread inflammatory dermatitis with excoriations and impetiginization. Heavily involved areas include the face, neck, upper back, scalp, and the dorsum of the hands. The margins of the eruption are indistinct and the neck and flexures are more heavily involved with secondary changes of lichenification. You...

Dermatologic Physical Exam

Physical examination of pigmented lesions is a difficult task and is best approached by using the ABCD technique mentioned earlier in the chapter on atypical nevi (see Chapter 28). If a lesion is abnormal by these criteria, and especially if there is also a history of distinct change or evolution over the prior 6 to 12 months, there is a high probability of melanoma. Many benign moles will have one of these changes. A melanoma usually shows several or all. Asymmetry In Chapter 28, benign nevi...

Macrodistribution

Dorsum of hands, fingers, periungual tissue, and knees in children (see Fig. 4 Photos 11,12). 2. Beard area and neck in young adult men (see Fig. 5 Photo 13). 3. Periungual warts are usually associated with nailbiting. This habit must be controlled for successful treatment of the warts. Figure 4 Macrodistribution of verrucous warts in children. Figure 4 Macrodistribution of verrucous warts in children. 4. Common warts may occur at virtually any site on the skin or mucous membranes. Indicated...

Specific History

Pityriasis rosea (PR) is a common dermatitis that acts like a viral exanthem. Peak incidence is during the second and third decades, although it can occur at any age. Onset is acute and usually consists of the sudden appearance of a single skin lesion, referred to as the herald plaque or patch. About 5 of cases have a prodrome with mild constitutional symptoms, sore throat, GI complaints, and or cervical adenopathy. In a significant number of patients, the initial lesions are overlooked or...

Therapy

The treatment of acne involves skillful use of medications, avoidance of provoking factors, physical evacuation of cysts and comedones, and in some cases intense emotional support. Therapy must be tailored to each case and must be adjusted regularly as condi- Figure 4 Macrodistribution of acne vulgaris. Figure 4 Macrodistribution of acne vulgaris. tions change. In general, grade I and mild grade II acne can be treated with topical regimens. Moderate to severe grade II and grade III disease...

Clinical Application Questions

A 50-year-old male diabetic presents with an extensive eruption on the lower back and buttock areas. He complains of intermittent pruritus and occasional tender deep pimplelike lesions. 1. List the disorders that you should consider in the differential diagnosis of this patient's eruption. 2. How would you distinguish tinea corporis from the other disorders in your differential diagnosis 3. Where else on this patient's body is fungal infection likely to be found 4. If a diagnosis of fungal...

Conditions That May Simulate Herpes Simplex Recidivans

Both diseases are common in the central facial region, and both begin with small clear vesicles on an inflammatory base. Herpetic lesions tend to remain fixed and discrete, and the vesicles are small, 1 to 2 mm across, tightly grouped, and persist for longer periods. Facial HSV occasionally develops secondary impetigo, causing some diagnostic confusion. A smear with a Gram stain will often show bacteria with cases of impetigo. A Tzanck smear of a blister base will show herpes virus cytopathic...

Application Guidelines Systemic Lupus Erythematosus

If a malar rash is present at onset, it usually appears abruptly. Photosensitivity can be present but is not as prominent a feature in SLE as in cutaneous lupus erythematosus. Although skin lesions occur in 80 of SLE patients during the course of their disease, they are a presenting sign in only about 13 . Joint and other visceral symptoms predominate. Cutaneous lesions are nevertheless important because they constitute four of the 11 criteria used by the American Rheumatism Association to...

Conditions That May Simulate Acne Vulgaris

Papulopustular rosacea may resemble acne, but usually occurs on a backdrop of flushing and telangectasia. Comedones and cysts are absent except in rare cases when both diseases occur simultaneously. Most rosacea lesions are on the face. This localized eruption is almost exclusively limited to female patients. It presents with a localized papular and eczematous eruption with tiny pinpoint pustules in the perioral, perinasal, or periocular areas of the face. It superficially resembles acne, but...

Molluscum Contagiosum Dimple Warts

Anatomy Outline

A 16-year-old male high school student presents with a large number of papular lesions of recent onset in the right thoracic and axillary region. There is a second grouping of similar lesions on the right knee. The patient is on the wrestling team, desires removal of the lesions, and was sent to you by his wrestling coach to find out if they might be contagious. You suspect this is molluscum contagiosum. 1. What are the primary lesions you would expect to find in molluscum contagiosum 2. What...