Dermatology

Question 1

What is eczema herpaticum?

Answer 1

Herpes Simplex Virus (HSV) infection of the skin

Question 2

How might eczema herpaticum cause severe illness or death?

Answer 2

1. Physiological disturbance: fluid, electrolyte and protein loss via skin.
2. Dissemination to the brain
3. Secondary bacterial infections

Question 3

Patient has 1 month of joint pain and develops cutaneous oedema with subcutaneous hardening that starts in her legs, spreads to the trunks, arms and affects the distal regions of her limbs. Examination reveals linear depression in the skin parallel to the course of of superficial veins, more obvious when raising the arm, consistent with the ‘groove sign’ - what is the likely diagnosis?

Answer 3

Eosinophiic fasciitis

Question 4

54F with 6m h/o intensely itchy papules and vesicles on the elbows, knees and buttocks. She is otherwise well with mild diarrhoea. Bloods show low folate and low ferritin.

What is the diagnosis?

Which investigation would be best to confirm this condition?

Answer 4

Dermatitis herpetiformis (DH) as cutaneous manifestation of coeliac disease (CD).

Direct immunofluorescence of normal appearing perilesional skin for IgA deposits (92% sensitivity)

Question 5

Patient with coeliac disease presents with dermatitis herpetiformis.

What is the utility of IgA endomysial Abs in this scenario?

Answer 5

Not useful - recommend direct immunofluorescence of perilesional skin.

IgA endomysial Abs:

• Found in 80% of DH and 95% of CD
• Levels correlate well with CD gut disease
• Levels do NOT correlate well with CD skin lesions