case 1

Medenilla – Miranda C2 Group #1

Case 1Patient: 12 y/o boy

CC: severely pruritic papules

on the hands and feet

HPI1 month PTC pruritic erythematous papules, some

topped by a vesicle over the sides of the fingers and toes

lesions gradually spread to axillae and inguinal areas wakes up at night because of severe pruritus

younger brother and sister of the patient are beginning to have similar symptoms

Consultation

PEMultiple erythematous to hyperpigmented

papules mostly excoriated

Diameter Size: 0.3 to 0.6 cm

Areas of Predilection: the anterior and posterior trunkboth axillaeumbilicus inguinal areas elbowswristfingerwebstoewebs

Salient FeaturesSubjective

Pruritic erythematous papules on the fingers and toes which spread to the axillae and inguinal areas

Pruritus - more prominent at night

Siblings were noted to have similar symptoms

Salient FeaturesObjectivemultiple erythematous to hyperpigmented papules mostly excoriated

Diameter Size: 0.3 to 0.6 cm

Areas of Predilection: anterior and posterior trunk

both axillaeumbilicus

inguinal areas elbowswristfingerwebstoewebs

Differential Diagnosis

PediculosisMilaria RubraInsect Bites

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PediculosisThree varieties of flattened, wingless insects

that infest humansPediculus humanus var. capitis (head

louse)Pediculus humanus var. corporis (body

louse)Phthirus pubis (pubic or crab louse)

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PresentationPresentationLesion

Intense pruritus – scalp Excoriations in the scalp Secondary impetigo

Age of Predilection Principally – children May occur in adults

Area of Predilection scalp

Etiology Pediculus humanus var.

capitis

Lesion Intense pruritus – scalp Excoriations in the scalp Secondary impetigo

Age of Predilection Principally – children May occur in adults

Area of Predilection scalp

Etiology Pediculus humanus var.

capitis

PatientPatient Lesion

Multiple pruritic erythematous and hyperpigmented papules

Age 12 years old

Area of Lesion Sides of fingers and toes Gradually spread – trunk, axillae

and inguinal areas Umbilicus, elbows, wrists,

fingerwebs and toewebs Others

Wakes up at night because of severe pruritus

Brother, sister having similar symptoms

Lesion Multiple pruritic erythematous and

hyperpigmented papules Age

12 years old Area of Lesion

Sides of fingers and toes Gradually spread – trunk, axillae

and inguinal areas Umbilicus, elbows, wrists,

fingerwebs and toewebs Others



Pediculosis capitis

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Pruritus Erythematous macules /

urticarial wheals Excoriated papules

Area of Predilection Upper back (-) hands and feet

Hallmark Hyperpigmented, parallel

stretch marksEtiology

Pediculus humanus var. corporis

Lesion Pruritus Erythematous macules /

urticarial wheals Excoriated papules

Area of Predilection Upper back (-) hands and feet

Hallmark Hyperpigmented, parallel

stretch marksEtiology

Pediculus humanus var. corporis

PatientPatientLesion

Multiple pruritic erythematous and hyperpigmented papules

Age 12 years old

Area of Lesion Sides of fingers and toes Gradually spread – trunk,

axillae and inguinal areas Umbilicus, elbows, wrists,

fingerwebs and toewebsOthers



Lesion Multiple pruritic erythematous

and hyperpigmented papulesAge

12 years oldArea of Lesion

Sides of fingers and toes Gradually spread – trunk,






Pediculosis capitis

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Maculae cerulae – blue or slate-colored macules

Non-pruritic May include sides of the

trunk, inner aspects of thighAge of Predilection

adultsArea of Predilection

Genital region Hypogastrium Rarely, axillae and eyelashes

Etiology Pthirius pubis

Lesion Maculae cerulae – blue or

slate-colored macules Non-pruritic May include sides of the

trunk, inner aspects of thighAge of Predilection

adultsArea of Predilection

Genital region Hypogastrium Rarely, axillae and eyelashes

Etiology Pthirius pubis

PatientPatient


















Pediculosis pubis

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PATIENT MILIARIA RUBRA

LESION Multiple erythematous hyperpigmented papules (0.3-0.6 cm), mostly excoriated

Discrete, extremely pruritic, erythematous papulovesicles, may become confluent on a bed of erythema

AREA OF PREDILECTION

Anterior and posterior trunk, both axillae, umbilicus, inguinal area, elbows, wrists, finger and toe webs

Antecubital and popliteal fosse, trunk, inframammary areas (especially under pendulous breasts), abdomen ( especially at the waistline), and inguinal regions, these sites may become macerated because evaporation of moisture has been impeded

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PATIENT MILIARIA RUBRA

SEX Male Any gender

AGE 12 years old Any age, more common in infants

OTHERS Gradual spead to the body, awakening at night due to severe pruritus, seen in other family members

Accompanied by prickling, burning or tingling sensation, In infants, lesions occur on the neck, groin and axillae.In adults, lesions occur on covered skin where friction occurs; these areas include the neck, scalp, upper part of the trunk, and flexures. The face and volar areas are spared. In late stages, anhidrosis is observed in affected skin.

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SCABIES

Scabies of the foot

Scabies of the arm

Scabies of the hand

Scabies of the finger

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Mosquito bitesCommon cause of papular urticariaSever local reactions are seen in young

children with immunodefficiencyHypersensitivity reactions may occur

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Ants StingPainful,burning sting, whealingIntense pruritic sterile pustules develop at the site

Pustules, blisters formed following fire ant sting on hand, arm, leg and ankle.

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Caterpillar DermatitisIrritation is produced by the

hair (toxins)coming in contact with the skin.

Severe pain, local pruritic erythematous macules and wheals

May cause widespread persistent dermatitis

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ScabiesCaused by the itch mite, Sarcoptes scabieiCharacteristics

Pruritic papular lesions, excoriations & burrowsEczematization, lichenification, impetigo and

furunculosis maybe presentDull Red nodules may appear during active

scabies; these are 3-5 mm and may or may not itch

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ScabiesSevere itching begins with

the sensitization of the hostItching is most intense at

nightDuring the day- pruritus is

tolerableWomen - itching of nipples

associated with generalized pruritic papular eruption

Men – Itchy papules in the scrotum

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Sites of PredilectionFingerwebs, wrists, axillae, areolae,

umbilicus, lower abdomen, genitals, buttocks

Circle of Hebra - Imaginary Circle intersecting the main sites of involvement –axillae, elbows flexure, wrist and hands and crotch

Adults- Scalp and face are usually sparedInfants- commonly present over entire

cutaneous surface

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TransmissionOvercrowding and close living quartersCommon use of contaminated linen and clothing

**when more than one member of the family has pruritus, a suspicion of scabies should be aroused

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Diagnostic TestA positive diagnosis is made by the

demonstration of the mite under the microscopeTo identify the burrows quickly, a drop of india ink

and giemsa violet can be applied to the infested area, then removed with alcohol --thin threadlike burrows retain the ink

Benzyl benzoate 6-10% precipitated sulfur in white petrolatum

- Rubbed into skin from neck to the feet especially to the creases, perianal areas, umbilicus, and free nail edge and folds

- Washed off 8-10 hrs later

Permethrin 5% cream

- Most widely used

- Lethal to mites but has low toxicity for humans

Lindane benzene hexachloride

- Rarely used as a 1st line agent

Crotamiton

- Lower cure rates but when used, it should be applied on 5 successive nights and washed off 24 hrs after last use

Ivermectin

- Available in 3 and 6 mg pills at a dose of 200 mcg/kg

- Oral treatment is effective but in crusted type of scabies, it should be used with a topical agent

- Repeated 2 or 3 times at intervals of 1-2 wks

- Has good margin of safety but neurotoxicity may be possible

Management

Individuals with close contact should also be treatedAvoid close personal contact with affected personClothing and bed linen should be changed and

laundered thoroughly

case 1

Documents

pruritic papules

erythematous papulovesicle

inguinal areasumbilicus

severe pruritusbrother

inguinal areaspruritus

humanspediculus humanus

severe pruritusyounger

cmareas of predilection