commons kind is

8/11/2019 Commons Kind Is

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2/34

What is it?

28 year old femaleveteran complainsof burning,blistering lesionsaround her lipsafter a day at thebeach.


3/34

Herpes Simplex

Common triggers: fever, stress, and sun

Most common on the lips and genitalia

Tzanck smear: multinucleated giant cells


4/34

What is it?

46 year old man

complains of painful,

burning rash on hisleft chest.


5/34

Herpes Zoster

Recurrence of VZV in a specific nerve

Individual lesions are preceded by intense

local pain on then arise as grouped blisters

on an erythematous base, which may

become hemorrhagic and crusted


6/34

What is it?

46 year old healthy man with intenseitching of his groin and burning of his feet.


7/34

Tinea Cruris- jock itch

Chronic fungal infection of groin area,

usually associated with tinea pedis

Involves the groin, but NOT scrotum

Candida more likely to involve scrotum

Differential: erythrasma, candida


8/34

What is it?

Patient complains of enlarging rash in

groin without any itching.


9/34

Erythrasma

Caused by Corynebacterium minutissimum

Usually asymptomatic but can itch

Occur in flexural areas, especially in the groin and in

between toes; macules with fine scales and sharplydefined borders

Woods lamp: lesions are coral red because bacteriaproduce fluorescent porphyrins

Differential:

Tinea cruris: raised scaly border

Candidiasis: often has peripheral pustules

Therapy: erythromycin (topical or oral)


10/34

Woods Lamp with Erythrasma


11/34

What is it?

64 year old obese

female with history

of diabetescomplains of rash

under her breast.


12/34

Candidal Infection

Occur in most intertriginous or moist areas

Obesity, diabetes, immunosuppression, and

antibiotics are important risk factors

Therapy: topical with nystatin or

imidazoles, but may require oral keto or

fluconazole


13/34

What is it?

52 year old woman

notices darkening

of the skin aroundher neck.


14/34

Acanthosis Nigricans

Hyperkeratosis and hyperpigmentationwith velvety folds seen in the genital

region, axillary region, or nape of theneck

Associated with insulin resistance,obesity, or malignancy (especiallyadenocarcinoma of the GI tract)


15/34

What is it?

32 year oldkindergarten teachergrade teacher

complains of a diffuserash across his chestand back. He statesthat it started severaldays after a severe

sore throat.


16/34

Psoriasis

Typical lesion is a round sharply borderederythematous patch with silvery scale

Lesions shown is second most common form,guttate type, which usually occurs afterstreptocoocal infection

Elbows, knees, scalp, lumbosacral region

Differential: pityriasis rosea, dermatitis,secondary syphillis, drug eruption

Auspitz sign: when a patch is scraped away,tiny blood vessels are seen


17/34

What is it?

42 year old man

complains of this

diffuse rash acrosshis back and chest.

One week ago it

started with thelarge lesion in his

upper left chest.


18/34

Pityriasis Rosea

Initial lesion: herald patch (several cm wide erythematouspatch)

Secondary lesion several weeks later: Christmas tree

pattern on the back (several finely scaled papules arrangedalong the skin line)

Differential: fungal infection, secondary syphillis, guttatepsoriasis, drug eruptions

Patients usually asymptomatic and lesions resolve in 2-3

weeks without treatment. In African Americans, tends tobe more pruritic and may require systemic steroids.


19/34

Hypopigmented rash?

Patient complains of a rash onhis chest and back whichstarted 3 weeks ago. He did

not have time to visit his PCPprior his vacation, so he took apicture of the rash to show hisdoctor when he got back. Hewas surprised that the area of

the rash did not get tan overthe week. He presents to hisPCP with his picture.


20/34

Tinea Versicolor

Caused by Pityrosporum orbiculare, previously

called Malassezia furfur

Sharply defined, yellowish-brown macules withtiny scales on chest and back; these become

very visible by stroking with tongue depressor

KOH prep: spaghetti and meatball-like hyphae

and spores

Treatment: selenium sulfide lotion


21/34

What is it?

37 year old father

of toddler twins

presents with thisrash.


22/34

Ringworm

Caused by parasitic fungi

(Dermatophytosis)

May be spread by skin-to-skin contact, aswell as via contact with contaminated

items

Rx: Topical antifungals or pyrithionezinc (Head & Shoulders) shampoo


23/34

What is it?

37 year old manreturns from a

camping trip inConnecticut withcomplaints of fatigue,chills, headache,

muscle and joint aches,and rash as seen on hisflank.


24/34

Lyme Disease Borrelia burgdorferi is the predominant cause

Bacteria are transmitted to humans by the biteof infected hard ticks belonging to the genus

Ixodes Early manifestations include fever, headache,

fatigue, and a characteristic skin rash callederythema migrans

Late manifestations involve the joints, heart,and nervous system

Rx: doxycyline (adults), amoxicillin (children),and ceftriaxone


25/34

What is it?

36 year old woman

with history of

recurrent HSV of thelips presents with

these lesions.


26/34

Erythema Multiforme

Sharply defined, flat papules with sunkencenters; lesions have an iris or targetappearance

Caused by herpes, mycoplasama, or viralinfections; may also be caused by drugs

May progress to Stevens-Johnson syndrome ifmucosal involvement or toxic epidermal

necrolysis Treatment: symptomatic treatment only;

systemic steroids may even be harmful insevere cases


27/34

What is it?


28/34

Seberrhoic Keratosis

Exophytic waxy brownish papules and plaques;appear that they can be easily scraped orflicked off

Unknown etiology

Usually benign, however, when erupt suddenly,they may represent a paraneoplastic syndromecaused by tumor production of epidermalgrowth factors


29/34

What is it?

82 year old man concerned about somelesions on his forehead.


30/34

Actinic Keratosis

Sharply bordered, erythematous lesions

with slight scale that eventually can

become thick and crusted Early lesions are often easier to find by

palpaion than by visual examination

Pre-cancer lesions of SCC (small % willturn to cancer over 10-15 years)


31/34

Acne in an adult?

62 year old man

presents to your

office complainingthat friends have

noted worsening rash

on face and slightenlargement of my

nose.


32/34

Rosacea

Central facial erythema with some

telangectasias initially, progressing to

papules and pustules Etiology unknown but many patients

have an abnormal flushing response to

various substances Therapy: topical metronidazole; severe

forms oral tetracycline or metronidazole


33/34

What is it?

Pt complains of sudden-onset of diffuse, itchyrash across his chest, back, abdomen, arms, andupper thighs. He states that he was started on a

new blood pressure medicine two days prior torash.


34/34

Drug-induced exanthem

Well recognized with many drugs including

Anticonvulsants

Aspirin and NSAIDs

Antibiotics: penicillins

Sulfonamides

Usually no specific investigation is undertaken

CBC may show leukopenia, thrombocytopenia, andeosinophilia in patients with serious drug eruptions.

Rx: remove suspected drug(s); antihistamines+/- steroids

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