alegre. almora. alonzo. amaro. amolenda. anacta. andal. ang. ang. ang. dermatology case 2:

alegre. almora. alonzo. amaro. amolenda. anacta. andal. ang. ang. ang.

Dermatology Case 2:

EG 43 y/o F

Chief Complaint:Plaques and Nodules on the face, trunk, and extremities

HISTORY OF PRESENT ILLNESS3

8 months PTC

6 month PTC

• Few erythematous ill-defined asymptomatic patches over both upper extremities

-associated tingling sensation and numbness of the hands and forearms

•No consult was done nor medications taken

• Plaques and nodules involving the forehead, malar area, left ear, trunk and extremities

CONSULT

FAMILY HISTORY

(+) HPN, DM(-) similar lesion

PHYSICAL EXAMINATION

Skin: multiple erythematous to skin-colored plaques and

nodules 1.5x 3.5 to 2.0 x 4.0 cm over the malar area, helix of ears, upper extremities, thighs

(+) leonine facies(-) madarosis

CLINICAL IMPRESSION

Salient Features erythematous ill-

defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)

(+) leonine facies (-) madarosis

Lepromatous type of Leprosy (Hansen’s Disease)

DIFFERENTIAL DIAGNOSIS

Hansen’s Disease (other types)Erythema multiformeFixed drug reaction Seborrheic dermatitisCellulitisUrticariaExfoliative dermatitis

Seborrheic Dermatitis

also known as seborrhea

common non-contagious condition of skin areas rich in oil glands (the face, scalp, and upper trunk) marked by flaking (overproduction of skin cells) and

sometimes redness and itching (inflammation) of the skin

varies in severity from mild dandruff of the scalp to scaly, red patches on the skin.


Epidemiology: with redness and flaking = 3–5% of the population affects all races; worse in men, and starts after puberty

(although babies have a version called cradle cap) and peaks around the age of 40 and then may improve

Cause: due to a combination of an over production of skin oil and

irritation from a yeast, Pityrosporum ovale.

Risk: Stress, fatigue, weather extremes, oily skin, infrequent

shampoos or skin cleaning, use of lotions that contain alcohol, skin disorders (such as acne), or obesity

Familial

Patient’s Data Patient’s Data EG 43 y/o F erythematous ill-



EG 43 y/o F erythematous ill-





Lesion Scanty, loose, dry, moist or

greasy scales and by crusted pinkish or yellowish patches

Age of Predilection Starts at puberty and

peaks at the age of 40

Signs & Symptoms: Scalp is itchy and sheds

white, oily skin flakes. In darker skin, some of the

affected areas may look lighter in color.

Lesion Scanty, loose, dry, moist or

greasy scales and by crusted pinkish or yellowish patches

Age of Predilection Starts at puberty and

peaks at the age of 40

Signs & Symptoms: Scalp is itchy and sheds

white, oily skin flakes. In darker skin, some of the

affected areas may look lighter in color.

Patient’s Data Patient’s Data EG 43 y/o F erythematous ill-



EG 43 y/o F erythematous ill-





Site of Predilection Areas has patches of red,

scaly skin: the scalp, hairline,

forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit; Flexors of elbow and knee

Classifications Mild – only some flaking and

redness in a few small areas. Moderate – several areas

affected with bothersome redness and itch.

Severe – large areas of redness, severe itch and unresponsive to self-care measures.

Site of Predilection Areas has patches of red,

scaly skin: the scalp, hairline,

forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit; Flexors of elbow and knee

Classifications Mild – only some flaking and

redness in a few small areas. Moderate – several areas

affected with bothersome redness and itch.

Severe – large areas of redness, severe itch and unresponsive to self-care measures.


The diagnosis is based on the appearance and location of the skin lesions In rare cases - skin biopsy to r/o other diseases

Therapeutic Plans Shampoo several times a week

Selenium sulfide, zinc pyrithionate, tar and resorcin shampoos

Topical Antifungals Ketoconazole 2% cream

Corticosteroid creams

(Differential Dignosis)

(brief description of pathology)(epidemiology, incidence, etc.)

Patient’s Data Patient’s Data erythematous ill-defined

asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)


erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)


(Differential…) (Differential…) (pertinent data per

differential)

(pertinent data per differential)


(diagnostic evaluation)(therapeutic plans)







differential)


alegre. almora. alonzo. amaro. amolenda. anacta. andal. ang. ang. ang. dermatology case 2:

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