Dermatology Cases Flashcards
Sammy is a 4 month old boy with an itchy rash. Born via normal vaginal delivery, mother had uncomplicated pregnancy. Immunisations are up-to-date. Mother is asthmatic and has allergic rhinitis. Father had eczema as a baby.
Rash is on face, arms, legs and trunk for a few weeks. Mum’s been using tea tree oil.
Baby seems distressed by the itchy rash. Mum notices that baby keeps rubbing the face.
Questions
What other questions do you want to ask mum?
What is the diagnosis?
What is the management?
Other Questions to Ask
Any fever?
General well being – feeding well, normal
number wet nappies, active, sleeping well
Is itchiness disturbing sleep
Use of soap to wash baby
Other treatments tri
Dx:
Diagnosis – eczema
Management:
- Use soap substitutes to bathe
- Stop use of tea-tree oil as it may be causing contact dermatitis
- Moisturise regularly
- Avoid excess heat – clothing, synthetic bedding
- Can use gloves to reduce scratching
- Explain to mum that eczema can be controlled and not cured, but with improve with age (75% by age 5)
- May be less likely with family history of atopy
- Intermittent use of topical steroids
- Infections – molluscum contagiosum, staphylococcus aureus, herpes simple
- Aeroallergens – pollens, grasses, animal dander, house dust mite
- Food allergies rarely
- Severe eczema – skin testing
Robert is a 24y.o. chef with a rash on the outside of his right and left elbows. He has tried some 1% hydrocortisone cream purchased over the counter and it cleared the rash for a short time; however it recurs each time he stops using it.
Works long hours in the kitchen, which is often very hot. Lives alone. Smokes 10-20 cigarettes per day.
The rash is annoying him and getting him down. Socialising less and is worried customers would think the rash is contagious.
Questions
What other questions do you want to ask Robert?
What is the diagnosis?
What is the management?
Other Q:
- Explore impact on his life
- Is scalp affected?
- Nails?
- Any joint pain?
- Family history psoriasis/autoimmune conditions, personal history autoimmune conditions
- How does he use the steroid cream?
Diagnosis - psoriasis
- Inflammatory immune-based disorder with genetic predisposition
- Activated T-lymphocytes release cytokines that cause keratinocyte proliferation
- Approximately 1.5% population significantly affected by it
- Increases risk of cardiovascular disease, diabetes, depression, psoriatic arthritis
Management
- • Reassure psoriasis is not infectious
- • Symptomatic treatment, no cure
- • Stress, heat, cold, smoking, new medications can trigger/exacerbate
- • Many topical treatment options
- • Moisturisers
Dermatologist referral
- Light therapy
- Retinoids
- Traditional systemic therapy – methotrexate, cyclosporine
- Immunomodulatory drugs
- 35yo Caucasian lady with skin lesion on back
- A lot uncertainty regarding duration and change
- Sun exposure
Q1. What is the provisional diagnosis and differential diagnoses?
Q2. What are the possible consequences if le? untreated?
Q3. How would you treat this?
1. Differential diagnoses?
- Melanoma
- Dysplastic naevi
2. Left untreated?
- If left untreated, melanoma can metastasis and eventually cause death
- Generally good 10 year survival rate if treated and fully excised
- Prognosis dependent of thickness of melanoma
Q3. How would you treat this?
- Surgical excision
- •Prevention in future with good sun protection
- •Education for patient to return if any new spots or changes
- 3yo child brought in by mother
- Potentially exposed to new foods at birthday party
- Relatively quick onset
- Puritic, widespread rash
Q1. What is the provisional diagnosis and differentials?
Q2. What do you think could have caused this?
Q3. What are the red flags that you need to look out for in this case?
Q4. How would you treat this?
Q5. What would you advise the parents regarding the source and prevention in the future?
1. Differentials?
- Allergic urticaria
- Infective – scabies (less likely due to rapid onset)
- chickenpox (less likely due to rapid onset and likelihood of vaccination
2. Caused this?
- Food
- Allergens in unfamiliar environment
- New soaps/washing powder/linen/shampoo
3. Red Flags
- Anaphylaxis
- Itchy throat
- Swelling in mouth
- Feeling they cannot breath
4. Tx
- Treat with oral antihistamines
- If concerned regarding lip swelling or breathing – can treat with oral steroids
5. Source & Prevention Advice
- Common allergens – nuts, soy, dairy, seafood, grasses•May not necessarily ever find the cause
- Slowly introduce new foods and observe for reaction
- If can find the cause – avoid in future
