disclosure of relevant relationships with industrydermexampreprefresher/08... · disclosure of...
TRANSCRIPT
![Page 1: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/1.jpg)
DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY
Nicole Burkemper, MD
Associate Professor of Dermatology and Pathology
Saint Louis University
I HAVE NO RELEVENT RELATIONSHIPS WITH ANY COMPANIES
![Page 2: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/2.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Cellulitis
C. Neuropathic diabetic ulcer
D. Pyoderma gangrenosum
E. Sweet syndrome
![Page 3: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/3.jpg)
![Page 4: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/4.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Cellulitis
C. Neuropathic diabetic ulcer
D. Pyoderma gangrenosum
E. Sweet syndrome
![Page 5: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/5.jpg)
Cellulitis
• Ill-defined erythema, warmth, edema
• Systemic symptoms of fever, chills and malaise
• Leading edge not raised or sharply demarcated (distinguishes from erysipelas)
• Bullae and petechiae
• Streptococcus pyogenes and Staphylococcus aureus
• Often after wound; on leg, tinea pedis is most common portal of entry
• Predisposing factors: venous and lymphatic damage, congenital vascular malformations
![Page 6: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/6.jpg)
Distractors
Allergic contact dermatitis *—epidermal changes
Neuropathic diabetic ulcer—sole of foot
![Page 7: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/7.jpg)
Distractors
Pyoderma gangrenosum *—sharply marginated wet ulcer with purple undermined border
Sweet’s syndrome *—pink edematous plaques on the face, upper trunk and arms
![Page 8: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/8.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Cutaneous candidiasis
C. Lichen sclerosus
D. Tinea corporis
E. Tinea versicolor
![Page 9: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/9.jpg)
![Page 10: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/10.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Cutaneous candidiasis
C. Lichen sclerosus
D. Tinea corporis
E. Tinea versicolor
![Page 11: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/11.jpg)
Tinea versicolor
• Presents as hypo- or hyperpigmented coalescing scaly macules
• Trunk, upper arms and neck
• Caused by Malassezia furfur
• KOH—short, thick hyphae and spores (“spaghetti and meatballs”)
• Topical or systemic antifungal treatment
• Recurrence rate very high—ketoconazole shampoo weekly to prevent recurrence
![Page 12: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/12.jpg)
Distractors
Allergic contact dermatitis *—pink patches or plaques, not hypo- or hyperpigmented; patterned
Cutaneous candidiasis *—moist patches in intertriginous areas with satellite pustules
![Page 13: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/13.jpg)
Distractors
Lichen sclerosus *—atrophic “cigarette paper” plaques often in genital and perianal areas
Tinea corporis *—annular, sharply circumscribed, erythematous, scaly patches
![Page 14: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/14.jpg)
The most likely diagnosis is:
A. Contact dermatitis
B. Cellulitis
C. Erythema migrans
D. Erythema dyschromicum perstans
E. Psoriasis
![Page 15: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/15.jpg)
![Page 16: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/16.jpg)
The most likely diagnosis is:
A. Contact dermatitis
B. Cellulitis
C. Erythema migrans
D. Erythema dyschromicum perstans
E. Psoriasis
![Page 17: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/17.jpg)
Contact dermatitis
• Well-demarcated erythematous vesicular to scaly plaque with well-defined margins corresponding to the area of contact
• Because irritant contact dermatitis and allergic contact dermatitis not always discernible clinically, patch testing may be required to identify an allergen and exclude allergy
• Most common allergens are nickel, neomycin, balsam of Peru, fragrance mix, thimerosal (often not relevant), gold, quaternium-15, formaldehyde, bacitracin and cobalt
![Page 18: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/18.jpg)
Distractors
Cellulitis *—more well-defined, erythematous and edematous; leg most common site
Erythema migrans *—annular patches most commonly on legs, groin, axilla and trunk
![Page 19: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/19.jpg)
Distractors
Erythema dyschromicum perstans—ashy-gray oval macules and patches on the face, neck, trunk and proximal extremities in patients with darker skin types
Psoriasis *—more well-demarcated bright red plaques with overlying silvery scale
![Page 20: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/20.jpg)
This patient just returned from a beach vacation in the Caribbean and complains of this itchy rash on the buttock. The most likely
diagnosis is:
A. Allergic contact dermatitis
B. Cutaneous candidiasis
C. Cutaneous larva migrans
D. Perianal strep dermatitis
E. Scabies
![Page 21: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/21.jpg)
![Page 22: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/22.jpg)
This patient just returned from a beach vacation in the Caribbean and complains of this itchy rash on the buttock. The most likely
diagnosis is:
A. Allergic contact dermatitis
B. Cutaneous candidiasis
C. Cutaneous larva migrans
D. Perianal strep dermatitis
E. Scabies
![Page 23: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/23.jpg)
Cutaneous larva migrans
• Most commonly caused by larvae of cat and dog hookworm, Ancylostoma braziliense; SE United States, Caribbean
• From environment contaminated with animal feces, beach
• Human is dead-end host
• Sxs: 1-6 days from exposure; creep several cm per day; die in 2 to 8 weeks without treatment
• Tx: single-dose ivermectin or 3 days albendazole
![Page 24: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/24.jpg)
Distractors
Allergic contact dermatitis *—can be linear, not serpiginous
Cutaneous candidiasis *—Often in the folds; beefy red, moist patches with satellite pustules
![Page 25: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/25.jpg)
Distractors
Perianal strep dermatitis—Perianal well-demarcated rim of erythema
Scabies *—Short burrows that prefer the finger webs, wrists, axillae, areolae, umbilicus and genitals
![Page 26: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/26.jpg)
This patient presents with fatigue and anemia. The most likely diagnosis is:
A. Basal cell nevus syndrome
B. Blue rubber bleb nevus
syndrome
C. Gaucher disease
D. Pachyonychia congenita
E. Peutz Jeghers
![Page 27: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/27.jpg)
![Page 28: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/28.jpg)
This patient presents with fatigue and anemia. The most likely diagnosis is:
A. Basal cell nevus syndrome
B. Blue rubber bleb nevus
syndrome
C. Gaucher disease
D. Pachyonychia congenita
E. Peutz Jeghers
![Page 29: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/29.jpg)
Blue rubber bleb nevus syndrome
• Autosomal dominant
• Dark blue papules and nodules and skin-colored compressible protuberances (“rubber blebs”) and larger venous malformations affecting skin and mucosa
• GI lesions bleed and lead to iron deficiency anemia
![Page 30: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/30.jpg)
Distractors
Basal cell nevus syndrome
*—palmar pits Gaucher disease
• Bronze coloration of skin;
some have congenital
ichthyosis
![Page 31: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/31.jpg)
Distractors
Pachyonychia congenita—”doorstop nails”; steatocystomas when mutations in keratin 17
Peutz-Jeghers *—hyperpigmented
macules on lips and oral mucosa;
polyposis of SI with GI bleeding
![Page 32: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/32.jpg)
The most likely diagnosis is:
A. Cellulitis
B. Ichthyosis vulgaris
C. Mycosis fungoides
D. Necrolytic migratory erythema
E. Psoriasis
![Page 33: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/33.jpg)
![Page 34: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/34.jpg)
The most likely diagnosis is:
A. Cellulitis
B. Ichthyosis vulgaris
C. Mycosis fungoides
D. Necrolytic migratory erythema
E. Psoriasis
![Page 35: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/35.jpg)
Ichthyosis Vulgaris
• Ichthyosis is derived from the Greek word
ichthys, meaning “fish”
• Autosomal dominant; prevalence as high as 1 in 250
• Onset in early childhood
• Extensor LE primarily affected with scales; hyperlinear palms
• Loss-of-function mutations in the filaggrin gene
(FLG)
![Page 36: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/36.jpg)
Distractors
Cellulitis * —well-defined erythema, warmth, edema; no scale
Mycosis fungoides *—fairly well-demarcated patches/plaques typically in sun-protected areas
![Page 37: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/37.jpg)
Distractors
Necrolytic migratory erythema *—pink and eroded plaques classically in intertriginous areas
Psoriasis *—well-demarcated red plaques with silver scale
![Page 38: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/38.jpg)
This patient also has a fever. The most likely diagnosis is:
A. Acne keloidalis
B. Arthropod bites
C. Nummular dermatitis
D. Prurigo nodularis
E. Sweet syndrome
![Page 39: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/39.jpg)
![Page 40: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/40.jpg)
This patient also has a fever. The most likely diagnosis is:
A. Acne keloidalis
B. Arthropod bites
C. Nummular dermatitis
D. Prurigo nodularis
E. Sweet syndrome
![Page 41: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/41.jpg)
Sweet syndrome
• Acute febrile neutrophilic dermatosis
• Adults; F3:M1
• Sharply demarcated, tender, pink-violaceous edematous plaque involving face, neck, upper trunk and extremities
• Fever, arthralgias, myalgias
• Elevated ESR and neutrophilia
• Associated with URI (most common), hematologic malignancy or solid tumors, inflammatory diseases and pregnancy
• Standard treatment is systemic corticosteroids
![Page 42: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/42.jpg)
Distractors
Acne keloidalis *—no fever; papules, pustules and keloidal plaques at back of neck
Arthropod bite *—no fever; edematous papule, plaque or bulla
![Page 43: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/43.jpg)
Distractors
Nummular eczema *—no fever; discrete, coin-shaped vesicular or crusted pruritic plaques
Prurigo nodularis *—no
fever; pruritic dome-shaped
papules
![Page 44: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/44.jpg)
This condition becomes more prominent with cold
exposure. The most likely diagnosis is:
A. Erythema ab igne
B. Livedo reticularis
C. Lymphangioma
D. Necrolytic acral erythema
E. Small vessel vasculitis
![Page 45: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/45.jpg)
Add close up or bigger version of photo
![Page 46: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/46.jpg)
This condition becomes more prominent with cold
exposure. The most likely diagnosis is:
A. Erythema ab igne
B. Livedo reticularis
C. Lymphangioma
D. Necrolytic acral erythema
E. Small vessel vasculitis
![Page 47: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/47.jpg)
Livedo reticularis
• Netlike, mottled or reticulated, pink or reddish-blue discoloration of the skin, mostly on the legs
• Livedo racemosa (fixed LR)—broken circular segments; almost always associated with significant systemic disease such as hypercoagulable states (including myelodysplasias, cancer, and antiphospholipid and Sneddon syndromes), vasculitis (especially medium- and large-vessel), emboli, medications, and neurologic disorders
![Page 48: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/48.jpg)
Livedo racemosa
![Page 49: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/49.jpg)
Distractors
Erythema ab igne—no
variability with temperature;
reticulated erythema or
pigmentation in area of of
persistent heat exposure
Lymphangioma *--no worse with change in temperature; white vesicles that can become hemorrhagic (frog spawn)
![Page 50: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/50.jpg)
Distractors
Necrolytic acral erythema *—no change with temperature; dusky plaques on feet +/- hands
Small vessel vasculitis *—no change with temperature; palpable purpura
![Page 51: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/51.jpg)
The most likely diagnosis is:
A. Darier disease
B. Lichen planus
C. Onychomycosis
D. Psoriasis
E. Yellow nail syndrome
![Page 52: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/52.jpg)
![Page 53: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/53.jpg)
The most likely diagnosis is:
A. Darier disease
B. Lichen planus
C. Onychomycosis
D. Psoriasis
E. Yellow nail syndrome
![Page 54: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/54.jpg)
Onychomycosis
• Yellowing, hypertrophy, and dystrophy of the distal nail plate with subungual hyperkeratosis (distal subungual onychomycosis)
• Trichophyton rubrum most common cause
• Usually multiple nails
• Toenail infection is much more common than fingernail infection
• Nail dystrophy is secondary to onychomycosis in more than 50% of cases (90% dermatophytes)
![Page 55: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/55.jpg)
Distractors
Darier disease *—red and white longitudinal streaks; V-shaped nicking of distal margin
Lichen planus *—dorsal pterigium; trachyonychia (twenty nail dystrophy)
![Page 56: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/56.jpg)
Distractors
Psoriasis *—salmon patches, “oil drop” sign, pitting, onycholysis; can be clinically indistinguishable from onychomycosis
Yellow nail syndrome *—marked thickening and yellow discoloration
![Page 57: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/57.jpg)
The most likely diagnosis is:
A. Cowden syndrome
B. Epidermodysplasia verruciformis
C. Heck disease
D. Traumatic fibromas
E. Tuberous sclerosis
![Page 58: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/58.jpg)
![Page 59: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/59.jpg)
The most likely diagnosis is:
A. Cowden syndrome
B. Epidermodysplasia verruciformis
C. Heck disease
D. Traumatic fibromas
E. Tuberous sclerosis
![Page 60: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/60.jpg)
Cowden syndrome
• Autosomal dominant; PTEN tumor suppressor gene
• Mucocutaneous findings: – Facial papules: flesh-colored, flat-topped, or elongated verrucoid
papules ranging from 1- to 5-mm
• Most are trichilemmomas and have a keratin-plugged center
– Oral lesions: 1- to 3-mm smooth whitish oral papules on gingiva, lips, palate or tongue in 80%
• May coalesce giving “cobblestone” appearance
– Acral keratoses: flesh-colored smooth or verrucoid papules on dorsal hands and feet in 60%
• Neoplasms of the breast and thyroid occur in up to two thirds of patients, can be malignant
![Page 61: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/61.jpg)
Distractors
Heck disease
• Small white to pink papules diffusely in the mouth, not on face; HPV-13
Epidermodysplasia verruciformis—flat, wart-like lesions on dorsal hands, extremities, face and neck; tinea versicolor type patches on trunk; HPV-5 and -8
![Page 62: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/62.jpg)
Distractors
Traumatic fibromas—solitary, smooth, pink nodule at bite line of buccal or labial mucosa or tongue; no skin findings
Tuberous sclerosis *—oral findings are gingival fibromas and dental pits; would also have facial angiofibromas
![Page 63: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/63.jpg)
The most likely diagnosis is:
A. Acne vulgaris
B. Eosinophilic folliculitis
C. Pityriasis lichenoides
D. Prurigo nodularis
E. Steatocystoma multiplex
![Page 64: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/64.jpg)
![Page 65: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/65.jpg)
The most likely diagnosis is:
A. Acne vulgaris
B. Eosinophilic folliculitis
C. Pityriasis lichenoides
D. Prurigo nodularis
E. Steatocystoma multiplex
![Page 66: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/66.jpg)
Acne vulgaris
• Comedones, papules, pustules, cysts, scarring
• Patients have a variety of lesions in various states of formation and resolution
• Follicular hyperkeratosis, ↑ sebum production, Propionibacterium acnes bacteria, inflammation
• Retinoids = 1st line for all forms of acne vulgaris due to their comedolytic and anti-inflammatory effects as well as their ability to help penetration of other topicals
![Page 67: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/67.jpg)
Distractors
Eosinophilic folliculitis—papulopustules and plaques studded with pustules and central clearing; no comedones; pruritic
Pityriasis lichenoides *—eroded or scaly papules that heal with hypopigmentation; no comedones
![Page 68: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/68.jpg)
Distractors
Prurigo nodularis *—dome-shaped nodules with central crust in accessible areas
Steatocystoma multiplex—Yellowish cysts without puncta; no pustules
![Page 69: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/69.jpg)
![Page 70: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/70.jpg)
![Page 71: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/71.jpg)
![Page 72: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/72.jpg)
![Page 73: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/73.jpg)
This patient presents with fever and rash. The most
likely diagnosis is:
A. Acute generalized
exanthematous pustulosis
B. Bacterial folliculitis
C. Disseminated zoster
D. Measles
E. Toxic epidermal necrolysis
![Page 74: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/74.jpg)
![Page 75: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/75.jpg)
![Page 76: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/76.jpg)
This patient presents with fever and rash. The most
likely diagnosis is:
A. Acute generalized
exanthematous pustulosis
B. Bacterial folliculitis
C. Disseminated zoster
D. Measles
E. Toxic epidermal necrolysis
![Page 77: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/77.jpg)
Acute generalized exanthematous pustulosis (AGEP)
• Fever and countless nonfollicular, sterile, 1- to 2-mm pustules on background of erythema
• Typically ≤4 days of new drug
• β-lactam antibiotics, macrolides, Ca++ channel blockers, antimalarials…
• Treatment: Drug cessation, topical steroids, antipyretics
• Acuity and drug history help distinguish from pustular psoriasis
![Page 78: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/78.jpg)
Distractors Bacterial folliculitis *—follicular pustules without background erythema
Disseminated zoster *—vesicles (not pustules) on an erythematous base; immunocompromised
![Page 79: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/79.jpg)
Distractors
Measles—morbilliform eruption; spreads cephalocaudad; no pustules
Toxic epidermal necrolysis *—painful, pink to dusky-red patches with vesicles, bullae and erosions; mucosal erosions
![Page 80: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/80.jpg)
This patient also complains of loss of the eyebrows. Of the following, the most likely diagnosis is:
A. Androgenetic alopecia
B. Central centrifugal cicatricial alopecia
C. Lichen planopilaris
D. Telogen effluvium
E. Trichotillomania
![Page 81: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/81.jpg)
![Page 82: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/82.jpg)
This patient also complains of loss of the eyebrows. Of the following, the most likely diagnosis is:
A. Androgenetic alopecia
B. Central centrifugal cicatricial alopecia
C. Lichen planopilaris
D. Telogen effluvium
E. Trichotillomania
![Page 83: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/83.jpg)
Lichen planopilaris
• Keratotic plugs surrounded by violaceous rim on the scalp resulting in scarring alopecia
• Peri-infundibular lymphocytic inflammation with vacuolar interface dermatitis
• Women affected more frequently than men • Frontal fibrosing alopecia is a variant of LPP that presents in
older women with bandlike frontotemporal scarring alopecia with loss of eyebrows
• Treatment often difficult—hydroxychloroquine; topical, IL and po steroids, pioglitazone (PPAR-gamma agonist) and immunosuppressive agents
![Page 84: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/84.jpg)
Distractors
Central centrifugal cicatricial
alopecia--almost exclusively
black women; scarring alopecia
at the vertex or crown
Androgenetic alopecia *—thinning of
crown with wider part anteriorly and
preservation of frontal hairline
![Page 85: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/85.jpg)
Distractors Telogen effluvium—thinning of hair of entire scalp, not just crown
Trichotillomania *—patches of alopecia with hairs of varying lengths interspersed with uninvolved areas of the scalp
![Page 86: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/86.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Amyloidosis
C. Dermatomyositis
D. Necrobiotic xanthogranuloma
E. Xanthelasma
![Page 87: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/87.jpg)
![Page 88: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/88.jpg)
The most likely diagnosis is:
A. Allergic contact dermatitis
B. Amyloidosis
C. Dermatomyositis
D. Necrobiotic xanthogranuloma
E. Xanthelasma
![Page 89: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/89.jpg)
Amyloidosis
• Primary systemic amyloidosis (AL amyloid)
– Multiorgan disease with underlying plasma cell dyscrasia
– Cutaneous manifestations in 25%: • Purpura/ecchymoses (most common)
• Rubbery swelling and infiltration of tongue/oral mucosa
• Waxy infiltration of palms/fingertips
• Waxy or purpuric periorificial papules
• Diffuse sclerodermoid infiltration
• Bullae
• Onychodystrophy
![Page 90: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/90.jpg)
Cutaneous amyloidosis
• Macular amyloidosis: brown rippled macules, often on back
• Lichen amyloidosis: persistent, brown, pruritic papules/rippled plaques on the shins
• Nodular amyloidosis: waxy nodule(s) often at acral sites, AL amyloid but rare progression to systemic amyloidosis
![Page 91: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/91.jpg)
Distractors
Allergic contact dermatitis *—scaly pink patches
Dermatomyositis *—violaceous erythema (heliotrope)
![Page 92: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/92.jpg)
Distractors
Necrobiotic xanthogranuloma--indurated yellowish plaques that can ulcerate
Xanthelasma--yellow papules and plaques
![Page 93: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/93.jpg)
The most likely diagnosis is:
A. Grave disease
B. HAART-associated
lipodystrophy
C. Lupus panniculitis
D. Rosacea
E. Scleromyxedema
![Page 94: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/94.jpg)
![Page 95: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/95.jpg)
The most likely diagnosis is:
A. Grave disease
B. HAART-associated
lipodystrophy
C. Lupus panniculitis
D. Rosacea
E. Scleromyxedema
![Page 96: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/96.jpg)
HAART-associated lipodystrophy
• Lipodystrophy occurs in up to 80% of HIV-infected patients, most of whom are on anti-retroviral therapy
• Fat of the face, buttocks and limbs is lost with increased fat at the upper back and abdomen
• Related to non-nucleoside reverse transcriptase inhibitors which also lead to adipocyte apoptosis
• May also have hypertriglyceridemia, hypercholesterolemia and insulin resistance, especially if also on a protease inhibitor
• Treatment with rosiglitazone, metformin, growth hormone and fillers
![Page 97: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/97.jpg)
Distractors
Grave disease—
exophthalmos
Lupus panniculitis *—
proximal extremities;
nodules or indurated
plaquesatrophy
![Page 98: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/98.jpg)
Distractors Rosacea *—conjunctivitis, styes; centrofacial erythema, papules and micropustules
Scleromyxedema--waxy firm papules that coalesce into infiltrated plaques
![Page 99: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/99.jpg)
The most likely diagnosis is:
A. Brown recluse spider bites
B. Bed bug bites
C. Erythema migrans
D. Scabies
E. Sporotrichosis
![Page 100: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/100.jpg)
![Page 101: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/101.jpg)
The most likely diagnosis is:
A. Brown recluse spider bites
B. Bed bug bites
C. Erythema migrans
D. Scabies
E. Sporotrichosis
![Page 102: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/102.jpg)
Bites, stings, infestations
• Excoriated, pruritic papules, often grouped
• Central puncta
• Exaggerated responses: bullous lesions or papular urticaria more common in children
• Bedbug bites (Cimex lectularius) often linear
![Page 103: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/103.jpg)
Distractors
Erythema migrans *—erythematous expanding annular plaque; usually solitary
Brown recluse spider bite—Painful edematous reaction progressing to bulla with surrounding erythema and ischemia
![Page 104: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/104.jpg)
Distractors
Scabies *—burrows in finger webs, umbilicus, nipples, male genitalia
Sporotrichosis *—ulcerated papule at site of inoculation (hand) and nodules along path of lymphatic drainage
![Page 105: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/105.jpg)
The most likely diagnosis is:
A. Confluent and reticulated papillomatosis
B. Hailey-Hailey disease
C. Recurrent and disseminated infundibulofolliculitis
D. Tinea versicolor
E. Transient acantholytic dermatosis
![Page 106: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/106.jpg)
![Page 107: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/107.jpg)
The most likely diagnosis is:
A. Confluent and reticulated papillomatosis
B. Hailey-Hailey disease
C. Recurrent and disseminated infundibulofolliculitis
D. Tinea versicolor
E. Transient acantholytic dermatosis
![Page 108: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/108.jpg)
Confluent and reticulated papillomatosis
• Onset: puberty-young adulthood, more common in black patients
• Multiple brown verrucous papules/patches, central chest/abdomen/upper back; confluent centrally and reticulated peripherally
• May mimic tinea versicolor (KOH will be negative) or acanthosis nigricans
• Treatment: Minocycline, azithromycin, topical and oral retinoids
![Page 109: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/109.jpg)
Distractors Hailey-Hailey disease *—macerated plaques in intertriginous areas
Recurrent and disseminated infundibulofolliculitis--numerous, pruritic, 1-2 mm skin-colored papules on trunk, neck and upper extremities; darker pigmented patients
![Page 110: DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRYDermExamPrepRefresher/08... · DISCLOSURE OF RELEVANT RELATIONSHIPS WITH INDUSTRY Nicole Burkemper, MD Associate Professor of Dermatology](https://reader031.vdocuments.us/reader031/viewer/2022040910/5e833650be5d88435730e68d/html5/thumbnails/110.jpg)
Distractors Tinea versicolor *—brown, tan or hypopigmented scaly round to oval patches on trunk
Transient acantholytic dermatosis *—crusted pink papules on upper trunk of older adults