differential diagnosis. case 1: non-scaly papules a 27 yo call center agent complains of...
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Differential Diagnosis
• Case 1: Non-scaly papulesA 27 yo call center agent complains of erythematous papules & nodules on the face especilally on the forehead, chin, cheeks & chin. She claims that she's had this problem since she was high school. Her elder brother had the same lesions.
Patient 27/F Miliaria Rubra ("heat rash", "prickly heat")
retention of sweat as a result of occlusion of eccrine sweat ducts that produces an eruption
Age of onset since high school persons of any age, but most common in infants
Epidemiology hot, humid, tropical climatesEtiology high heat and humidity
Typical lesion erythematous papules & nodules discrete, extremely pruritic, erythematous papulovesicles
Course days to weeks of exposure to hot environmentSites frequently
affectedon the face ( forehead,
cheeks & chin)antecubital, popliteal fossae, trunk, inflammatory areas, abdomen,
inguinal regions; face and volar areas are sparedManagement prickling, burning or tingling-like pain
Patient 27/F Miliaria Rubra ("heat rash", "prickly heat")
retention of sweat as a result of occlusion of eccrine sweat ducts that produces an eruption
Age of onset since high school persons of any age, but most common in infants
Epidemiology hot, humid, tropical climatesEtiology high heat and humidity
Typical lesion erythematous papules & nodules discrete, extremely pruritic, erythematous papulovesicles
Course days to weeks of exposure to hot environmentSites frequently
affectedon the face ( forehead,
cheeks & chin)antecubital, popliteal fossae, trunk, inflammatory areas, abdomen,
inguinal regions; face and volar areas are sparedOther clinical
features prickling, burning or tingling-like pain
Management controlling heat and humidity; removal of occlusive clothing, lots of fluids and cooler environment
Patient 27/F Scabies (“the Itch”)
Sarcopetes scabiei (itch mite)Age of onset since high school persons of any age
Epidemiology egalitarian; crowded and unhygienic living conditions Etiology skin-to-skin contact with an infected person, contaminated linens
Typical lesion erythematous papules & nodules pruritic papular lesions, excoriations and burrows
Course previously exposed: 2-4 daysno exposure: 4-6 weeks
Sites frequently affected
on the face ( forehead, cheeks & chin)
finger webs, wrists, axillae, areolae, umbilicus, lower abdomen, genitals and buttocks; scalp and face are spared
Other clinical features
intense pruritus (intense at night)women: itching of the nipples
men: itchy papules on the scrotum and penisManagement Permethrin 5% cream (Elimite)
Patient 27/FInsect Bites
beetles, mitesAge of onset since high school persons of any age
Epidemiology mostly children and those who work outdoorsEtiology insect bites
Typical lesion erythematous papules & nodules
Grain Itch: urticarial papule, intense pruritusBeetles: papulovesicular and urticarial dermatitis
Course immediateSites frequently
affectedon the face ( forehead,
cheeks & chin)Grain Itch: trunk
Beetles: chest, neck and forearmsOther clinical
features Pain, slight burning and tingling of the skin
Management Antihistamines; calamine lotion
Patient 27/F Acne Vulgaris
Chronic inflammatory disease of the pilosebaceous folliclesAge of onset since high school begins at puberty (15-18y/o)
“disease of the adolescents”Epidemiology Adolescent: M > F
Not limited to adolescent12% of women and 5% of men at age 25 years have acne
By age 45 years, 5% of both men and women still have acneEtiology Hyperproliferation of keratinocytes
Propionibacterium acnesTypical lesion erythematous papules
& nodulescharacterized by comedone, papules, nodules, pustules, and
even scarsCourse
Sites frequently affected
on the face ( forehead, cheeks & chin)
affects face, neck, upper trunk and upper arms
Management topical treatment - Topical Retinoids, Benzoyl Peroxide, Topical Antibacterials, Sulfur, Sodium Sulfacetamide, Resorcin,
and Salicylic Acid, Azeleic AcidOral antibiotics – tetracycline, erythromycin, clindamycin
Other antibiotics – Sulfonamides, Trimethoprim-sulfamethoxazole, Trimethoprim, Dapsone
Patient 27/F Furuncles / Carbuncles
Furuncles are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue
Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring;
smaller and more superficial than subcutaneous abscessesAge of onset since high school Young people
Epidemiology M > FEtiology Staphylococcus infection
Typical lesion erythematous papules & nodules
nodule, pustule, or an acute, round, tender, circumbscibed perifollicular staphylococcal abscess
Carbuncles = two or more confluent furuncles with separate heads
Course most undergo central necrosis and rupture through the skindischarge purulent, necrotic debris;
often continue for a prolonged period by autoinoculationSites frequently
affectedon the face ( forehead,
cheeks & chin)hair-bearing regions: beard area, nape, axilla, buttocks, but may
occur anywhereOther clinical
featurescarbuncles may be accompanied by fever and prostration
Management Warm compress, Penicillinase-resistant penicillins, 1st gen cephalosporin, Bactroban oinment, Incision and drainage
Furuncle
Carbuncle
Patient 27/F Pediculosis capitis Pediculosis corporis Pediculosis pubis
infestation of lice -- blood-feeding ectoparasitic insects of the order Phthiraptera
Age of onset since high school school-age children (3-10 years old)
Epidemiology F > MBlack race - rare
M > FAdults > children
Etiology Pediculosis humanis var. capitis
(head louse)
Pediculosis humanae var.
corporis ( body louse)
Phthirus pubis(crab louse)
Typical lesion erythematous papules & nodules
Erythematous macules, or
urticarial wheals;Excoriated papules,
parallel linear stretch marks;
Transmission Head-to-head contact (most
efficient);Through inanimate
objects will play (shared combs and
brushes )
shared towels may play a role
Sexually transmitted
Patient 27/F Pediculosis capitis Pediculosis corporis Pediculosis pubis
Sites frequently affected
on the face ( forehead, cheeks & chin)
scalp upper back;no involvement of
hands and feet
usually seen in the hairy areas of the
vulvaOther clinical
featuresintense pruritus of the scalp; affected hair becomes dry
and lusterless
generalized itching; pigmented
thickening of skin from continued
scratching
characterized by constant itching
Management PermethrinPyrethrins,
combined with piperonyl butoxide
Proper hygiene;Destruction of lice:
Laundering the beddings and
clothing, Disinfection
Topical application of 1% Permethrin cream rinse (Nix)
which is applied to affected area and wash off after 10
minutes;1% Lindane
shampoo (Kwell), applied for 4
minutes to affected area and
subsequently washed off
Pediculosis Capitis
Pediculosis corporis
Pediculosis pubis
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