Workshop: Red Scaling Eruptions, Erythroderma, and Corticosteroids

Question 1

54-year old male, Fitzpatrick Type 4 with a 3-year history of this pruritic eruption.

List the primary and two secondary morphologies represented by this photo

what topical therapy is most appropriate

Answer 1

1. erythematous plaeus on lower extremities
2. white -lichenified scaling. possivle erosions due to pruritis.

for therapy- i don’t think this is a candida or tinea infection, most likely psoriasis or AD. because it’s not on a sensitive area it could be a moderate steroid–betamethasone

• to prevent stinging, avoid lotion and try an ointment

Question 2

description and treatment

Answer 2

bright red papules coaelscing to plaques. secondary erosions, possible edmatous.

• there’s a large amount of skin involved

this is atopic dermatitis. betamethasone ointment. this is a child and clobetasol is too storng.

Question 3

Answer 3

a = ptyriasis rosea

B= atopic dermatitis

c= lichen plannus

d= psoriasis

Question 4

description and most appropriate therapy?

Answer 4

1. red papules or patches periorally, blanching of the lips
2. scale and crust- yellow.
   - this might be an acute AD. proably not impetigo cause there’s not relaly clustery pustules or big amount of swelling/inflammation indicating a staph A infection.– BUT: impetigo often goes together with secdonary impetigization happening in the openings of AD
   - it’s a peds face– small amount of hydrocortisone cream. avoid lotion because it would sting in the erosions.

Question 5

outline these subtypes of dermatitis

Answer 5

1. acute
2. subacute
3. chronic

Question 6

acute AD vs bullous pemphigoid

Answer 6

Ad has more of a dermatitic/red background. BP doesn’t have a red scaly background. it also is moreso seen in older adults, whereas AD can happen any age

Question 7

description

Answer 7

scaling/lichenification with excoriations that might be cuasing hypopigmentation/

• this could be atopic dermatitis (chronic), psoriasis (less likely), lichen planus (less lichey cause LP is more patchy)

Question 8

• 53-year old hairdresser
with a history of Atopic Dermatitis since childhood.

• Her usual eruption has been worsening however despite using appropriate topical therapy

Other Diagnostic Considerations?

Answer 8

she is already predisposed with sensitive skin. she is a hair dresser–working with difficult chemicals. she may have an allergic contact dermatitis causing the excoriation and scaley red plaques.

Question 9

prototypical reactions of ACD caused be:

Answer 9

poison ivy and nickel. need patch testing for accurate and consistent diagnosis

Question 10

What topical therapy is most appropriate? 1. Betamethasone 0.1%
lotion
2. Topical antimicrobial
ointment effective
against S. aureus
3. 1% Hydrocortisone
lotion
4. Bethamethasone
0.1% ointment

Answer 10

4. the lotion would sting

Question 11

23 yr old with a 10 day hx of slightly pruritic eruption

characteristic patch?

Answer 11

herald patch– pytyriases rosea

Question 12

treatment options for pityriasis rosea

Answer 12

supportive mostly–it usually resolves on its own

• mild hydrocorticosteroid and antihistamines if it’s pruritic

Question 13

Diagnosis?

Answer 13

lichenification of buccal mucosa. reticulated white plaque consistent with florid lichen plannus

-

Question 14

this is palmar distribution in pityriasis rosea, but what else should be excluded from Ddx?

Answer 14

exclude erythema nodosum (target lesions due to HSV)

exclude syphillus

Question 15

4 year history – painful
pustules – history of
plaque psoriasis 10 years
previously

what potency class of topical steorid should be prescribed

Answer 15

this is pustular psoriasis. eczema has spongiosis; vesicles on skin. need a high potency steroid because it’s on a thicker skinned area and it’s very inflammed. this is where clobetasole comes in

Question 16

What topical therapy would you prescribe?

Answer 16

this is nail psoriasis. psoriatic nail disease involving pitting and onycholysis and oildrop sign.

needs a hardcore steroid– potentially systemic

Question 17

What sign is represented by the arrow?

Answer 17

auspitz sign- characteristic of psoriasis or lichen plannus. this looks more like psoriasis tho

Question 18

Outline a therapeutic ladder

Answer 18

1. general measures for dry skin
2. topical corticosteroid
3. anthrylyn and tar
4. photo therapy
5. systemic immunosuppression with methotrexate

Question 19

diagnosis?

Answer 19

sharply demarcated erythematous plaque with some scale

• psoriasis
• candida intertrigo?
• erythema nodosum?
• red man syndrome/erythroderma?

Question 20

diagnosis

Answer 20

inverse psoriasis

Question 21

Answer 21

seborhheic dermatitis

Question 22

This patient has 90% BSA with this eruption

Answer 22

erythroderma– this person is SICK