78 years old man presented with the above pruritic rashes of 6 months duration.
Tuesday, January 30, 2007
Monday, January 29, 2007
Dermatoses of Pregnancy
Here are two cases of pruritic lesions in pregnant patients:
Case 1
26 years old G1P0 at 27 weeks of POA, presented with the above pruritic papules and nodules over her abdomen, upper and lower limbs. She claimed the lesions were drier 2 days post-partum.
Case 2
25 years old G1 P0 at 12 week of POA, presented with the above pruritic papules over the upper and lower limbs of three weeks duration.
What is it among the 6 types of dermatoses of pregnancy?
Prurigo of pregnancy.
Related case in Derm round 1.
Case 1
26 years old G1P0 at 27 weeks of POA, presented with the above pruritic papules and nodules over her abdomen, upper and lower limbs. She claimed the lesions were drier 2 days post-partum.Case 2
25 years old G1 P0 at 12 week of POA, presented with the above pruritic papules over the upper and lower limbs of three weeks duration.What is it among the 6 types of dermatoses of pregnancy?
Prurigo of pregnancy.
Related case in Derm round 1.
Tuesday, January 23, 2007
Derm round 7
Case 1
25 years old man presented with the above lesions of three weeks duration.
Diagnosis?
Pitted keratolysis.
More:
DermNet NZ.
eMedicine.
Case 2
58 years old lady, with history of right breast CA and mastectomy done, developed the above lesions after given two cycles of chemotherapy.
Diagnosis?
?Vitiligo
Case 3
65 years old man presented with the above painful lesions over the anterior chest wall with small vesicles and discharges. He was told by the GP that it was shingles. Patient was very concerned and decided to seek 2nd opinion.
The lesion appeared in a straight line, with areas of crusting and serous discharge. It did not confine to a typical dermatomal area.
Diagnosis?
Most likely insect bite reaction.
Case 4
29 years old guy, presented with the above non-pruritic rashes over three weeks duration over the body, first started over the left shin.
On examination, there was scattered ring-liked erythematous papules with skight scaling over the back of the trunk. There was also a bigger such lesion over the left shin. Fungal scrapping was negative.
Diagnosis?
Pityriasis rosea (Note the herald patch).
Case 5
25 years old lady presented with the above pigmented lesions over the back of three years duration, which were non-pruritic.
On inspection, there was areas of reticular hyperpigmented macules with fine scaling seen.
Fungal scrapping was negative.
Diagnosis?
Initially thought it was Pityriasis vesicolor, however scrapping was negative.
My friend suggested that it could be Becker's naevus. (However, I didn't see obvious overlying hair).
The above lesions were noted on the body of a 55 years old man. He is asymptomatic. He said such lesions had appeared on the body since he was teenage.
Diagnosis?
Becker's naevus (Note the overlying hair).
25 years old man presented with the above lesions of three weeks duration.Diagnosis?
Pitted keratolysis.
More:
DermNet NZ.
eMedicine.
Case 2
58 years old lady, with history of right breast CA and mastectomy done, developed the above lesions after given two cycles of chemotherapy.Diagnosis?
?Vitiligo
Case 3
65 years old man presented with the above painful lesions over the anterior chest wall with small vesicles and discharges. He was told by the GP that it was shingles. Patient was very concerned and decided to seek 2nd opinion.The lesion appeared in a straight line, with areas of crusting and serous discharge. It did not confine to a typical dermatomal area.
Diagnosis?
Most likely insect bite reaction.
Case 4
29 years old guy, presented with the above non-pruritic rashes over three weeks duration over the body, first started over the left shin.On examination, there was scattered ring-liked erythematous papules with skight scaling over the back of the trunk. There was also a bigger such lesion over the left shin. Fungal scrapping was negative.
Diagnosis?
Pityriasis rosea (Note the herald patch).
Case 5
25 years old lady presented with the above pigmented lesions over the back of three years duration, which were non-pruritic.On inspection, there was areas of reticular hyperpigmented macules with fine scaling seen.
Fungal scrapping was negative.
Diagnosis?
Initially thought it was Pityriasis vesicolor, however scrapping was negative.
My friend suggested that it could be Becker's naevus. (However, I didn't see obvious overlying hair).
The above lesions were noted on the body of a 55 years old man. He is asymptomatic. He said such lesions had appeared on the body since he was teenage.Diagnosis?
Becker's naevus (Note the overlying hair).
Saturday, January 20, 2007
Derm round 6
Case 1
29 years old gentleman, presented with the above pruritic lesions of two years duration. He has been applying numerous creams he took from GP clinics as well as bought from the phamarcies.
Diannosis?
Tinea incognito.
More:
DermNet NZ.
Case 2
39 years old gentleman, with long-standing DM of more than 10 years, presented with the above lesions of 3 years duration. He is asymptomatic.
Diagnosis?
Pityriasis vesicolor.
More:
eMedicine
29 years old gentleman, presented with the above pruritic lesions of two years duration. He has been applying numerous creams he took from GP clinics as well as bought from the phamarcies.Diannosis?
Tinea incognito.
More:
DermNet NZ.
Case 2
39 years old gentleman, with long-standing DM of more than 10 years, presented with the above lesions of 3 years duration. He is asymptomatic.Diagnosis?
Pityriasis vesicolor.
More:
eMedicine
Monday, January 15, 2007
Derm round 5
Case 1
A 15 years old lady with port wine stain lesions over her left upper arm was treated in the Plastic surgery clinic with laser.
She was referred to the dermatology clinic for further management of the above lesions over the right upper arm which were present since childhood (>10 years). The patient is asymptomatic.Diagnosis?
By one look, this is Keratosis pilaris.
(On further questioning, similar lesions were present over her thigh).
More:
eMedicine
KeratosisPilaris.org
AOCD
DermNet NZ
Case 2
65 years old man was recently diagnosed to have SVT and hypertension two months ago presented with the above pruritic body rashes of 2 weeks duration. He was prescribed aspirin, metoprolol, amiodarone and perindopril.Clinically, he had generalized erythrodermic skin which was thickened, dry and scaly with areas of scratch marks as well as excoriation, sparing the buttock and upper thigh.
Diagnosis?
Drug-induced photodermatitis.
Which drug is the most likely cause?
Amiodarone.
(Further history, patient admitted having exposed under sunlight regularly without shirt on during gardening)
More:
DermNet NZ
University of Maryland Medical Center
Cx of CryoTx
Overzealous application of liquid nitrogen on a plantar wart, resulting in a huge bulla over the foot of a five-year-old boy after five days.Thursday, January 11, 2007
Derm round 4
Case 1
24 years old lady, G1P0 at 15 week of POA was found to be anaemic (Hb 7.8gm/dl) during routine blood check and was admitted for further management. Further history, she complained of red facial rashes started since she was found pregnant. She also complained of mild on and off arthralgia. The was no alopecia, oral ulcer or proximal myopathy. Her TWBC was low (3.4) and her ESR was also high (78 mm). Clinically, she has erythematous facial rashes in distribution suggestive of possible photodermatitis (pic not shown). The above was the appearance of her hands, which showed periungual erythema. We are currently working her up for connective tissue disease.
Case 2
78 years old lady, with no previous medical illness, presented with the above nodular and hyperpigmented lesions over her lower limbs of 10 months duration. Note that, there were some healed hyperpigmented scars. Currently, she presented with worsening lesions with pain, ulceration and pus discharge. We thought it might be some deep fungal infection (?Acinomycetoma)
Case 3
The above 78 years old man, with previous history of IHD/DM/HPT/Dyslipidaemia/old stroke, presented with the above pruritic body lesions of one month duration. The lesion over the right knee had been there for 6 months. There was also a previous surgical scar of right knee surgery.
The body and upper limbs lesions were well defined, hyperpigmented, dry and scaly. Scalp and nails were normal. Fungal scrapping was negative.
I am thinking of some form of discoid ezema; with some differentials of ?psoriasis/? CTCL.
Any comment regarding the above pictures?
24 years old lady, G1P0 at 15 week of POA was found to be anaemic (Hb 7.8gm/dl) during routine blood check and was admitted for further management. Further history, she complained of red facial rashes started since she was found pregnant. She also complained of mild on and off arthralgia. The was no alopecia, oral ulcer or proximal myopathy. Her TWBC was low (3.4) and her ESR was also high (78 mm). Clinically, she has erythematous facial rashes in distribution suggestive of possible photodermatitis (pic not shown). The above was the appearance of her hands, which showed periungual erythema. We are currently working her up for connective tissue disease.Case 2
78 years old lady, with no previous medical illness, presented with the above nodular and hyperpigmented lesions over her lower limbs of 10 months duration. Note that, there were some healed hyperpigmented scars. Currently, she presented with worsening lesions with pain, ulceration and pus discharge. We thought it might be some deep fungal infection (?Acinomycetoma)Case 3
The above 78 years old man, with previous history of IHD/DM/HPT/Dyslipidaemia/old stroke, presented with the above pruritic body lesions of one month duration. The lesion over the right knee had been there for 6 months. There was also a previous surgical scar of right knee surgery.The body and upper limbs lesions were well defined, hyperpigmented, dry and scaly. Scalp and nails were normal. Fungal scrapping was negative.
I am thinking of some form of discoid ezema; with some differentials of ?psoriasis/? CTCL.
Any comment regarding the above pictures?
Derm round 3
Case 1
A 13-year-old boy, presented with Dengue encephallitis and later developed Dengue Shock Syndrome, was ventilated in ICU for two weeks. He developed nosocomial infection and his blood C&S grew Acinetobacter species. He completed two weeks of IV Sulperazon and later transferred out to the general ward for further management. In the ward, he developed spikes of temperature again, which he was covered with IV Meropenem and IV Vancomycin. He had developed the above rashes over the body for few days, even before his spiking temperature and the introduction of IV antibiotics. The managing team was worried about the rashes, as they thought it might be the source of the sepsis, and thus referral to dermatologist.
Diagnosis?
Miliaria crystalina.
More:
Wikipedia.
eMedicine.
Dermnet.
Merck manuals.
Case 2
46 years old lady, presented with the above mild pruritic plague over her left shin of three years duration. Her blood sugar was normal.
Diagnosis:
Necrobiosis lipoidica (diabeticurom).
*Note:
Relationship to DM- 1/3 have clinical DM, 1/3 have abnormal glucose tolerance, 1/3 have normal glucose tolerance.
The above patient was found to be diabetic after 3 years on follow-up.
More:
eMedicine.
Case 3
Nail changes:
Sandwich of red and white longitudinal bands, with a V-shaped nick at the free margin of the nail.
Diagnosis:
Darier's disease.
More:
eMedicine.
A 13-year-old boy, presented with Dengue encephallitis and later developed Dengue Shock Syndrome, was ventilated in ICU for two weeks. He developed nosocomial infection and his blood C&S grew Acinetobacter species. He completed two weeks of IV Sulperazon and later transferred out to the general ward for further management. In the ward, he developed spikes of temperature again, which he was covered with IV Meropenem and IV Vancomycin. He had developed the above rashes over the body for few days, even before his spiking temperature and the introduction of IV antibiotics. The managing team was worried about the rashes, as they thought it might be the source of the sepsis, and thus referral to dermatologist.Diagnosis?
Miliaria crystalina.
More:
Wikipedia.
eMedicine.
Dermnet.
Merck manuals.
Case 2
46 years old lady, presented with the above mild pruritic plague over her left shin of three years duration. Her blood sugar was normal.Diagnosis:
Necrobiosis lipoidica (diabeticurom).
*Note:
Relationship to DM- 1/3 have clinical DM, 1/3 have abnormal glucose tolerance, 1/3 have normal glucose tolerance.
The above patient was found to be diabetic after 3 years on follow-up.
More:
eMedicine.
Case 3
Nail changes:
Sandwich of red and white longitudinal bands, with a V-shaped nick at the free margin of the nail.
Diagnosis:
Darier's disease.
More:
eMedicine.
Acrodermatitis continua of hallopeau
A 55 years old gentleman with long history of chronic plague psoriasis, had the following hand appearances.
At a glance, I thought it was psoriatic athritis mutilans, as there were deformities over the distal phalanges. It was characterized by fixed flexion deformity of the distal interphalangeal joints with obvious distal phalanges resorption.
However, my friend told me, it was Acrodermatitis continua of Hallopeau.Below are five pictures I downloaded from the internet, but they look quite different:
Here is a picture of arthritis multilans:
Acrodermatitis continua of Hallopeau is a chronic skin disorder characterized by recurrent sterile, pustular eruptions of the digits with marked involvement of the nail beds. The intermittent pustulations may lead to atrophy, onichodystrophy and even osteolysis.
More links:
www.vgrd.org
Dermatology:Case report (PDF)
Dermatology Online Journal
Tuesday, January 9, 2007
Derm round 2
Case 1
A 64 years old Chinese lady who has bilateral knee OA, was admitted two days earlier for an elective left total knee replacement. Previously, she had her surgery postponed once due to some non-specific ECG changes and she was asymptomatic.
On the day of the planned surgery, she complained to the doctor during morning round that she had this slightly pruritic rashes over the shin for more than three weeks. The plan was, surgery immediately cancelled, referal to dermatologist and to get new date in three weeks.
On inspection, there were patches of well-defined erythematous scaly lesions.
Diagnosis?
Tinea corporis (Fungal scrapping positive).
Poor little old lady.
Case 2
This is the second time I am seeing this kind of skin rashes.
65 years old Chinese man, complaint of numerous red spots over his lower limbs and some over the forearms, which were non-pruritic, of three weeks duration. No significant drug or allergy history. He just started working as a guard performing night duties in a guest house.
On inspection, there were multiple red spots with surrounding rim of hypopigmentation (halo-liked) noted mostly over the extensor surfaces of the limbs.
Diagnosis:
Insect bite reaction.
(Clue: Lesions only appeared on the areas not covered by clothing, he wore shorts all the time).
A 64 years old Chinese lady who has bilateral knee OA, was admitted two days earlier for an elective left total knee replacement. Previously, she had her surgery postponed once due to some non-specific ECG changes and she was asymptomatic.On the day of the planned surgery, she complained to the doctor during morning round that she had this slightly pruritic rashes over the shin for more than three weeks. The plan was, surgery immediately cancelled, referal to dermatologist and to get new date in three weeks.
On inspection, there were patches of well-defined erythematous scaly lesions.
Diagnosis?
Tinea corporis (Fungal scrapping positive).
Poor little old lady.
Case 2
This is the second time I am seeing this kind of skin rashes.65 years old Chinese man, complaint of numerous red spots over his lower limbs and some over the forearms, which were non-pruritic, of three weeks duration. No significant drug or allergy history. He just started working as a guard performing night duties in a guest house.
On inspection, there were multiple red spots with surrounding rim of hypopigmentation (halo-liked) noted mostly over the extensor surfaces of the limbs.
Diagnosis:
Insect bite reaction.
(Clue: Lesions only appeared on the areas not covered by clothing, he wore shorts all the time).
Derm round 1
Case 1
A 22 years old lady, currently pregnant (2nd pregnancy) at 12 weeks POA, presented with such prutitic rashes over the abdomen of one week duration. Similar condition appeared during her first pregnancy at 28 weeks POA.
Diagnosis?
Pruritic urticarial papules and plaques of pregnancy (PUPPP).
Dermatoses of pregnancy:
1. PUPPP.
2. Phemphigoid gestationis.
3. Prurigo of pregnancy.
4. Pruritic folliculitis.
5. Pustular psoriasis of pregnancy (Impetigo herpetiformis).
6. Cholestasis of pregnancy (Obstetric choletasis).
Case 2
Diagnosis?
Lichen amyloidosus.
More:
eMedicine
Case 3
7 years old Indian girl has such hyperpigmented rash over the right thigh since birth. It has increased in size over the years. For the last three months, she complained of tender on touching the lesion. On palpation, there were multiple subcutaneous nodules felt, which were tender. In addition, she has mulitple (>10) cafe-au-lait spots over her back.
Other significant history was, her father also has numerous cafe-au-lait spots, as well as numerous neurofibromata and axillary freckling; clinically consistent with Neurofibromatosis type1.
Diagnosis?
I am not too sure about it.
My boss said it is congenital hairy nevomelanocytic nevus, probably not related to NF1.
A 22 years old lady, currently pregnant (2nd pregnancy) at 12 weeks POA, presented with such prutitic rashes over the abdomen of one week duration. Similar condition appeared during her first pregnancy at 28 weeks POA.Diagnosis?
Pruritic urticarial papules and plaques of pregnancy (PUPPP).
Dermatoses of pregnancy:
1. PUPPP.
2. Phemphigoid gestationis.
3. Prurigo of pregnancy.
4. Pruritic folliculitis.
5. Pustular psoriasis of pregnancy (Impetigo herpetiformis).
6. Cholestasis of pregnancy (Obstetric choletasis).
Case 2
Diagnosis?Lichen amyloidosus.
More:
eMedicine
Case 3
7 years old Indian girl has such hyperpigmented rash over the right thigh since birth. It has increased in size over the years. For the last three months, she complained of tender on touching the lesion. On palpation, there were multiple subcutaneous nodules felt, which were tender. In addition, she has mulitple (>10) cafe-au-lait spots over her back.Other significant history was, her father also has numerous cafe-au-lait spots, as well as numerous neurofibromata and axillary freckling; clinically consistent with Neurofibromatosis type1.
Diagnosis?
I am not too sure about it.
My boss said it is congenital hairy nevomelanocytic nevus, probably not related to NF1.
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