Pearls_11

Question 1

Patient presents with pruritic, pink-to-purple, flat-topped papules or plaques on the wrists, ankles, and *mucosal membranes* and the *lower back* and *trunk* (see photos below and recognize Wickham striae)

Dx?

Assoc with what condition and what drugs?

Tx?

Answer 1

Dx

• lichen planus

Associate with:

• condition: Hep C
• drugs: ACEi, thiazides, Lasix, beta blockers

Tx

stop any of those meds and treat with topical steroids.

Question 3

Patient presents with sudden onset of a rash on the back, chest, and abdomen. It started 2 weeks ago as a single lesion on the back then quickly spread to its current locations (see image below)

Dx?

What type of bx and tx?

Answer 3

Dx: pityriasis rosea

-> you do not have to biopsy and no treatment is necessary -> will go away on it’s own.

Question 4

Patient presents with “rash” on her face described as small, red, pus-filled pustules and causes flushing on the mid-face (see photo below) with itchy eyes

Dx?

In terms of labial fold involvement, how can you dist this from lupus

Answer 4

Dx: Rosacea

Dist from lupus:

> DOES NOT SPARE NASOLABIAL FOLDS like Lupus does -

(rash sparing labial folds –> lupus)

(rash not sparing labial folds –> Rosacea)

Question 5

Rosacea

Tx inflammatory?

If you see comedones, is this Rosacea? If not, what is it?

Answer 5

Topical Flagyl

• Should not have comedones, and if it does, it’s likely acne instead of Rosacea.