Week 6

Question 1

A patient presents with well demarcated areas of depigmentation that fluoresce milky white under 365nm light. What is the most likely diagnosis? What is the pathophysiology of this disease?

Answer 1

Vitiligo. A disorder caused by autoimmune destruction of pigment-producing melanocytes in the skin. It can be present in ANY location of the body, and treatment regimens can include phototherapy, topical steroids, and topical immunosuppressants. Vitiligo may be associated with other autoimmune conditions, so work-up for thyroid dysfunction, diabetes, etc… is warranted.

Question 2

A number of nutritional deficiencies present with dermatologic findings. What are the classic signs of Scurvy? What is the missing nutrient ?

Answer 2

Scurvy (Missing Nutrient: Vitamin C): swollen, easily friable gums, easy bruising, and corkscrew hairs

Lecture: Autoimmune Systemic Disease

Objective 2: Describe cutaneous manifestations of various systemic diseases.

Question 3

A number of nutritional deficiencies present with dermatologic findings. What are the classic signs of Pellagra? What is the missing nutrient for this condition?

Answer 3

Pellagra (Missing Nutrient: Niacin/Vit B₃):

• Diarrhea
• Dermatitis (Casal’s Necklace - photosensitive dermatitis in a v-shaped distribution at the neck and chest)
• Death

Lecture: Autoimmune Systemic Disease

Objective 2: Describe cutaneous manifestations of various systemic diseases.

Question 4

A child comes in with numerous umbilicated papules (see below). You suspect poxvirus. What is your primary diagnosis? How would your follow up change if an adult came in with the same lesions?

Answer 4

Molluscum contagiosum.

While benign in children, widespread molluscum in adult individuals is indicative of severe immunosuppression and warrants immediate HIV testing.

Lecture: Viral exanthems

Objective 2: Explain viral classification, basic work up, first line treatments and available vaccinations for these illnesses.

Question 5

What is the classic description of lesions seen in patients with HHV-1 or 2? What information does the location of the lesions give you in determining whether HHV-1 or HHV-2 is the most likely cause of the lesions?

Answer 5

Classic Description: Clustered vesicles on a red base, erosions with scalloped borders (punched out erosion)

HHV-1 and HHV-2 are generally responsible for lesions in different areas. HHV-1 is responsible for peri-oral lesions and HHV-2 is found primarily in genital lesions.

Lecture: Viral exanthems

Objective 2: Explain viral classification, basic work up, first line treatments and available vaccinations for these illnesses.

Question 6

What feature distinguishes the facial rash seen in lupus versus dermatomyositis?

Answer 6

Whether or not the rash “hugs the nasolabial folds.” A malar rash (indicative of lupus), spares the nasolabial folds (left). The rash seen in dermatomyositis classically “hugs the nasolabial folds.” (right)

Lecture: Connective Tissue Diseases

Objective 1: Describe the cutaneous features of systemic connective tissue diseases: lupus erythematosus, dermatomyositis, rheumatoid arthritis, systemic sclerosis, and relapsing polychondritis.

Question 7

What antibodies can be used to differentiate diffuse cutaneous sclerosis vs. limited cutaneous sclerosis?

Answer 7

Limited cutaneous sclerosis is associated with anti-centromere antibodies with fibrotic changes limited to fingers, hands, and face. It is also associated with CREST syndrome.

Diffuse cutaneous sclerosis, which also includes truncal involvement, is associated with anti-Scl70 antibodies.