Clinical Presentations practice

Acne Vulgaris - Rosacea no comedones would be seen) - Corticosteroid induced acne (lacks comedones and in which pustules are usually in the same stage of development) - Perioral dermatitis ( typically is just around the mouth and orbital area) - Acneiform drug eruptions Start pt on topical retinoids and benzoyl peroxide ( this is the first line of treatment even in severe acne) If treatment fails recommend Oral Isotretinoin

14 year old boy presents with dozens of erythematous papules, pustules and cysts. On closer exam, he also has atrophic scars on the lateral forehead consistent with permanent scarring from pervious acne lesions. What is the diagnosis? Differential diagnosis? What medications would you start this patient on? What do you recommend if your treatment plan fails?

Herpes associated erythema multiforme (minor) Treat herpes virus with oral acyclovir, valacyclovir, famciclovir Supportive treatment ibuprofen and acetaminophen, recommend to stay hydrated let the pt know that desquamation is normal part of resolution of lesions

15 year old female presents with several red lesions on her palms and back of hands for 1 week. On examination, you note symmetrical, erythematous papular rash with targetoid lesions. What is the diagnosis? What do you recommend as treatment? How do you counsel the patient about the healing process?

PE- blanching erythematous patch with tenderness to palpation, +cap refill, no blisters present 1st degree burn not really a percent since small and on hand Acetaminophen or NSAIDs for pain, Bacitracin or aloe vera , ask if pt is UTD on tetanus vaccine, should heal within 7 days with no scarring

16 year F presents with a diffuse red patch to her right hand. She says she burned her hand while reaching for a pot on the stove. You suspect it is a 1st degree burn based on your physical exam What can you expect to find on the physical exam of this pt? What is the diagnosis? What percent burn is this? What do you recommend as treatment?

Erysipelas Fungal infection Cellulitis Seborrheic Dermatitis Oral abx; Penicillin, VK, dicloxacillin, cephalexin **Clindamycin/Erythromycin for PCN allergy Outpatient treatment failed = recommend admission for IV abx or broad spectrum abx

19 year old female presents with a painful rash on her left leg. She has a small bug bite in the area that she got 3 weeks ago. Since then, the area has become red, painful and hot. On physical exam you note shiny, raised, indurated and tender plaque like lesions on the left leg. The redness is well demarcated and hot to the touch. What is the diagnosis? Differential diagnosis? What is the first line of recommended treatment? What would you recommend if out patient therapy failed?

Folliculitis - Acne vulgaris - Acneiform eruptions - Cutaneous candidiasis - Insect bites Topical Mupirocin ( first line of defense for active localized infection) and topical disinfectant ( to limit spread of infection) Oral abx- cephalexin, amoxicillin

26 year old female presents with itchy, red pimples to the groin area that appeared a few days after shaving. Physical examination reveals small, tender, erythematous pustules and papules to bilateral groin. What is the diagnosis? What is the differential diagnosis? What would you recommend as treatment? What would you recommend as treatment if this patient had a widespread infection?

Epidermis and some superficial dermis showing, blanching, erythematous patch with serous or bloody blisters , +cap refill **most painful of all burns and is very tender to palpation Topical Silver sulfadiazine with bacitracin or aloe vera. Acetaminophen or NSAIDS for pain. Heals within 14-21 days, no scarring but may leave pigment changes. Debridement or skin graft depending on how severe

31 year old M presents saying that he burned his right forearm while roasting marsh-mellows with his kids. You suspect it is a superficial partial thickness second degree burn based on your physical exam. What would your findings be on a typical physical exam for this type of burn? What do you recommend as treatment?

Rosacea - Sun damage - Acne - SLE ( no papules or pustules would be present, malar rash would spare nasolabial folds) Treat with Topical Metronidazole (this is a topical abx- first line), may recommend in combination with systemic abx - Chlonidine for flushing - Tetracycline or erythromycin 250mg QID as needed - Alternative abx: Minocycline

46 year old white women presents with facial flushing that she notes is worse when she drinks alcohol and when she is stressed at work. Physical examination reveals the presence of localized facial erythema, telangiectasis as well as several scattered papules and pustules on her cheeks. What is the diagnosis? Differential Diagnosis? What would you recommend as treatment?

Impetigo Cutaneous Candidiasis Dermatophytic infections Topical Mupirocin (bactroban) Oral abx; cephalexin, doxycycline, Bactrim

5 year old girl presents with crusting facial lesions for 3 days. Her mother says that prior to development of facial lesions her daughter was scratching at insect bites. Physical Exam reveals a facial rash with a honey colored crust and pruritis What is the diagnosis Differential diagnosis What is the recommended first line of treatment? What is the recommended treatment for a widespread form of this disease?

Actinic Keratosis Cryosurgery, 5 FU cream, Imiquimod

69-year-old man with male-patterned baldness is concerned because the skin on his scalp is no longer smooth. He describes it as feeling rough, like "sandpaper." While he is now retired, he was a gardener and often spent hours working under the sun. Physical exam reveals discrete yellow-brown, scaly patches on sun-exposed areas of the face, scalp, ears, forearms, and the dorsum of the hands. What is the diagnosis? What would you recommend as treatment?

Pityriasis rosea Dont need treatment unless pt is uncomfortable - for pruritis --> oral antihistamine or topical antipruretic -short course systemic or topical glucocorticoids *phototherapy*

A 14-year-old boy presents to your office with a mildly pruritic rash that involves his chest and back. He reports it began with a single lesion on his back, but now has spread to involve his entire back and chest. You note on your examination the presence of several oval, scaly plaques that follow skin lines (Christmas tree distribution) What is the diagnosis? What do you recommend for treatment? What is the pathopneumonic finding in this disease?

Atopic Dermatitis - Topical Steroids are first line of treatment - Bathe only 1x per day with gentle cleanser and use hypoallergenic, unscented moisturizer after bathing - Wear cotton or synthetic materials (no wools) - Avoid rubbing and scratching; Hydroxzyzine or Benadryl - Tar preparations may improve lichenification - Second line treatments; Dermatologist immunosuppresants, topical tacrolimus (preferred) and pimecrolimus Common triggers- dust, pollen, food, weather changes, clothing, stress **increased flares in WINTER months ** 60% of patients develop AD <2 months old, **30% of patients by age 5 **often personal/family history of allergic rhinitis or asthma ** 30% of infants with AD develop asthma

A 25 year old male presents with pruritic dry scaly areas on the flexure surfaces of both hands. The skin is thickened and edematous with papules and plaques as well as erosions and some crusts. The patient states he has had similar lesions since he was a child. What is the diagnosis? What would you recommend as treatment? What are triggers for this disease

Androgenic Alopecia Female pattern baldness, Female hereditary baldness First line of treatment - Topical Minoxidil topical latanoprost to stimulate hair growth **Since pt is female you can use spironolactone but counsel pt about gynecomastia ** cannot use finasteride because it is teratogenic

A 26 year old female presents to your clinic c/o increased thinning of hair around her bangs over the past few months. On physical exam, you note an area of thinning hair to the crown of her head but no lesions or inflammation to the scalp. Pt denies any systemic symptoms. What is the diagnosis? What do you recommend as treatment?

Nummular eczema - Topical steroids = first line of treatment - Hypoallergenic, unscented moisturizers

A 30 year old male with PMHx of Atopic Dermatitis presents with several round, erythematous lesions to his bilateral arms. He reports having similar episodes in the past during winter. Physical exam shows several coin-like plaques composed of papules and vesicles with an erythematous base. What is the diagnosis? What do you recommend as treatment?

Epidermal inclusion cyst You would have to drain cysts and treat with abx before excising them. - Cyst forms within hair follicle due to plugged pilosebaceous gland or when epidermis cells are traumatically implanted into the dermis -Cyst is filled with epidermal cells and debris - Cyst can easily become infected -Connects with keratin filled pore

A 30-year old female presents to you on account of skin lesions on her face and chest. On examination, you notice a few firm, inflamed papules with size ranging from 0.3 cm to 1cm, and with overlying punctum. What is the diagnosis? What do you recommend as treatment? What is the pathophysiology of this disease?

Erythema infetiosum Allergic hypersensitivity reaction Measles Rubella Ibuprofen, acetaminophen, hydration and rest **stay away from pregnant women**

A 5 y/o M presents with a few days of stuffy nose, fever, and sore throat. Physical exam reveals a raised, erythematous maculopapular rash on his bilateral cheeks (slapped cheek appearance). You also notice a few spots of what appears to be a maculopapular rash on both arms. What is the diagnosis What is the differential diagnosis What would you recommend as treatment?

Seborrheic Dermatitis Scalp- antifungal ketoconazole or selenium shampoo Face- topical steroid and antifungal combination Better in summer months, flares in the fall

A 50 year old male presents with an area of redness and dry, flaking skin around the nasolabial folds. He also reports seeing little white flakes in his hair over the past few weeks. Physical exam reveals a discrete and confluent erythematous maculopapular rash to the nasolabial folds with areas of overlying desquamation. What is your diagnosis? What do you recommend for treatment? When is this condition better or worse?

Steven johnson syndrome DC offending medication Admit to ICU or transfer to burn center Manage fluid loss with IV hydration Systemic steroids and cyclosporine may increase survival IV ig Watch closely

A 60 year old female presents bilateral symmetrical bullae on a background of erythematous macules and patches in addition to erosions and peeling to both lower limbs with few lesions anywhere . else. You note several mucosal lesions. the pt says the rash began 48 hours after taking sulfonamide. What is the diagnosis? What do you recommend as treatment

Vitiligo treatment - neck first line; Tacrolimus - trunk first line; Topical steroids - Generalized pigementation; UV therapy, refer to dermatologist for pigmentation therapy

A 7 year old female presents with large patches of depigmentation affecting the neck, upper back and chest for the past 3 years. The whitish patches are sharply demarcated. What is the disease? What would you recommend as treatment?

Toxic epidermal necrolysis DC offending medication Admit to ICU or transfer to burn center Manage fluid loss with IV hydration Systemic steroids and cyclosporine may increase survival IV ig Watch closely

A 70 year old woman presents with extensive skin lesions. The patient says the rash began about 10 days after taking an anti-convulsant medication. You note that the rash overs bilateral legs, arms and trunk. On physical exam she has bilateral symmetrical bullae on a background of erythematous macules and patches in addition to peeling and erosion. You note that skin peels away in sheets when pressure is applied and rubbed. What is the diagnosis? what do you recommend as treatment?

Stasis dermatitis Manage venous insufficiency - leg elevation, walking, stockings Skin care - gentle cleansing, petroleum based hydration For pruritis, erythema, oozing - Topical Steroids - Wet dressings - Unna boot; specific dressing with covered elastic bandage (colloid like, moist)

A 75 year old female presents to your clinic c/o lower extremity swelling for the past few weeks. She says she has a history of heart failure. On physical exam you note bilateral lower leg swelling with areas of hyperpigmentation and erythema as well as some areas of skin cracking and weeping. She denies any pain but has some burning and itching. What is the diagnosis? What do you recommend as treatment?

Hand foot and mouth disease IDK Supportive treatment with ibuprofen and acetaminophen as needed with a prescription for magic mouth wash. ** be sure to counsel mother on appropriate use** lasts 7-10 days, no contact with other children, highly infectious and contagious

An 8 y/o girl presents with her mother to your clinic. The mother says that her daughter has had a low grade fever at home, has not been eating and appears fatigued. Physical exam reveals erythematous vesicular lesions around the mouth with a maculopapular rash to her feet and hands What is the diagnosis What is the differential diagnosis What would you recommend as treatment? How long can you tell the patient the course of the disease is expected to last?

Measles- Rubeola Supportive treatment and hydration - Ibuprofen, acetaminophen - Monitor for secondary infections Recommend titer and possibly vaccine to individuals he has been in contact with **resolves 7-10 days after onset

An unvaccinated child presents with a maculopapular, brick red rash on face beginning at the hairline and progressing to palms and soles. His mother says that 24-48 hours ago he had acough, coryza and conjunctivitis along with small red spots in buccal mucosa with a blue-white pale center that have improved. What is the diagnosis? What do you recommend as treatment?

Eczema

What class of skin disorders is characterized by pruritic, inflamed skin eruptions that often become erythematous>

Epidermis and deep dermis showing Red, yellow, pale, grey, white dry waxy appearance Blistering NONTENDER, may have some pain with pressure - Decreased 2 point discrimination (from nerve damage) **Absent cap refill Silver sulfadiazine, debridement and possible skin graft to prevent contractures Healing within 3weeks- 2 months Scarring is commom

What would you expect to see on as a clinical presentation/physical exam for a deep partial thickness burn? What would you recommend as treatment?

Entire skin damaged Waxy, white grey leathery, dry Painless - cap refill Silver sulfadiazine, IV hydration if extensive, Escharotomy, debridement, tissue reconstruction, skin graft Months to heal, does not heal well spontaneously

What would you expect to see on as a clinical presentation/physical exam for a full thickness burn? What would you recommend as treatment?

Type 3 Pseudo-acanthosis nigricans - Treat underlyng disorder (diabetes) - Recommend weight loss - Topical keratolytic or topical/systemic steroids

a 13-year-old obese male who is being seen for his routine physical presents to your clinic. His skin examination reveals velvety, hyperpigmented, papillomatous lesions of the neck and axillae. The remainder of the examination is unremarkable. The patient has a strong family history of diabetes. Laboratory analysis reveals a Hgb A1C - 5.9 (high), Insulin level - 18 (normal); lipids, CMP, T4, TSH, and cortisol are all normal. What is the diagnosis? What do you recommend as treatment?

Dyshidrosis, Pompholyx, Vesiculobullous hand eczema - wear gloves to prevent contact with water (like when cleaning dished) - topical steroids can be helpful (basically sucks for this kid) **Extremely common form of hand dermatitis **1/3-1/2 of patients have related contact allergy

a 13-year-old presents with a pruritic vesicular eruption comprised of clear, deep-seated vesicles without erythema erupting on the lateral aspects of fingers, the central palm, and plantar surfaces. What is the diagnosis? What do you recommend for treatment?

Pilonidal Disease I&D abscess, +/- abx , incise 1cm off deadline shave gluteal skin, remove hair from pits repeat every 1-2 weeks - Follicles in the midline gluteal cleft become blocked, infected and drain pus leaving open midline pits - Loose hair accumulates in the pits acting as a nidus of infection causing drainage to persist

a 15-year-old male presents with pain, discomfort and swelling above the anus and near his tailbone that comes and goes. He reports that the pain worsens when he sits or bends forward. Medical history is significant for metabolic syndrome. He is a high school student who spends hours playing on his Xbox. On physical exam, there is a tender and fluctuant mass that is erythematous. There is also purulent discharge from a sinus tract. What is the diagnosis? What do you recommend as treatment? What is the pathology of this disease??

Allergic contact dermatitis remove allergen, do not use that lipgloss brand - First line of treatment = topical steroids (carefully, may opt for moisturizer since it is lips)

a 16 year old female present with swelling and redness to her lips. She reports using lipgloss before going to the movies with her friends. Physical exam reveals a well defined area of erythema and edema to her lips and liplines with several papules. What is your diagnosis? What do you recommend for treatment?

Candidiasis Nystatin cream should clear up in 7-10 days

a 16-month-old brought by her mom for a diaper rash. On physical exam, you observe an erythematous "beefy" red rash in the diaper area with a sharp, marginated border and pinpoint satellite pustules at the edge of the erythema. What is the diagnosis? What would you recommend as treatment?

Lichen Planus topical steroids, topical cyclosporin, topical or systemic steroids, **phototherapy** - may reoccur if treatment discontinued - avoid oral steroids Wickham striae, fine white streaks on papules

a 16-year-old female with an acute eruption of violaceous, pruritic, polygonal, shiny, flat-topped papules involving the flexor surfaces. What is the diagnosis? What do you recommend as treatment? What is the pathopneumnic finding in this disease?

Simple drug eruption Discontinue offending agent - Benadryl and Hydroxyzine - Lesion should slowly resolve counsel the pt that healing process may involve desquamation

a 17-year-old female with severe widespread red rash involving mainly the trunk and extremities one day after she took oral cephalexin suspension for a sore throat. What is the diagnosis? What do you recommend as treatment?

Complex drug eruption- Major erythema multiforme - Oral IV, IM and systemic steroids Supportive treatment- hydration, manage pain, monitor for secondary infection **if treatment had been started before bullae formation clinical outcome would be better

a 20 year old female presents with fever, fatigue and severe severe swelling, bleeding and blisters to the lips and oral mucosa. She reports taking a new medication yesterday. On physical exam you note come targetoid lesions on the genital area and targeoid lesions confluent with bullae on her lips. What is the diagnosis? What do you recommend as treatment?

Hidradenitis suppurativa Intralesional steroid injection and I&D Topical Clindamycin - obesity, smoking, genetic predisposition to acne - Hair follicle becomes plugged with keratin - Apocrine duct dilates and becomes inflamed - Bacteria grow in stagnant gland - Gland ruptures creating surrounding inflammation and pain

a 27-year-old obese female presents with tender inflammatory nodules and abscesses in her axillae and anogenital area. The lesions have waxed and waned over the past few years but have become more painful and bothersome in the past month. Some of the larger lesions are foul smelling and are draining a purulent material. What is the diagnosis? What do you recommend as treatment? What are the predisposing factors for this disease? What is the pathophysiology for this disease?

Lipoma Excision, be sure to give abx regimen prior to excision to prevent secondary infection Neck, Trunk, extremities

a 30-year-old male presents c/o a non-painful mass on the upper back which has grown slowly over the past year. He denies previous trauma, drainage from the area or history of dermatologic diseases. Examination reveals a four centimeter firm, but highly mobile subcutaneous mass with no overlying skin discoloration or punctum with drainage. What is the diagnosis? What do you recommend as treatment? Where is this lesion usually seen?

Paronychia Warm soaks with chlorahexidine and oral abx

a 32-year-old female with a painful index finger. She obtains regular manicures, changing colors every 2 weeks. She recently had one a week ago and started feeling pain near the nail on her left index finger. Physical exam reveals redness, warmth, and pain along the nail margin of the index finger. When applying pressure to the nail plate, some pus drains from the nail. What is the diagnosis? What do you recommend as treatment?

Melasma Sunscreen and reduce UV exposure refer to dermatologist to reduce skin pigmentation

a 35 year old female presents c/o worsening hyperpigmentation to her face, particularly her cheeks. Physical exam shows diffuse light to dark brown macules to bilateral upper cheeks. The pt has no significant past medical history and her only medication is birth control. What is the diagnosis? What would you recommend as treatment?

Androgenic Alopecia (Male pattern baldness) First line of treatment - Topical Minoxidil (lengthens anagen phase) **since pt is male and young, you can use Finasteride (pre-mature baldness) which decreases androgens effect on the follicle BUT DOES NOT GROW NEW HAIR topical latanoprost - prostaglandin analog that may stimulate hair growth and encourage immature hairs to mature to catagen phase

a 35 year old male presents to your clinic c/o gradual thinning of his hair along the sides of his head. On physical exam you note thinning of hair to the temporal regions of this scalp re-shaping the anterior part of the hairline. The scalp appears normal and there is no evidence of inflammation or lesions. Pt denies any systemic symptoms. What is the diagnosis? What do you recommend as treatment?

Condyloma Patient applied treatments - Imiquid cream or podophylox solution Clinically applied- cryotherapy, podophyllin, surgical removal, electrodesiccation ** all warts should be removed they are precancerous

a 40-year-old married promiscuous male patient who admits to having recent intercourse with a male prostitute during a recent trip to Las Vegas. On physical exam you note several raised, cauliflower-like lesions in clusters on the shaft of his penis. He is very concerend stating that his wife will probably divorce him if she finds out.

Irritant contact dermatitis - Topical steroids - wear gloves when working with chemicals - Oral steroids given in taper

a 50 year old female presents with well defined areas of erythema to her hands and fingers. She reports working with cleaning products for several years. Physical exam shows well demarcated areas of erythema with some discrete vesicles and flaking. What is your diagnosis? What do you recommend as treatment? How would you treat a severe case? What are the predisposing factors for this disease?

Pemphigus Vulgaris Biopsy - Direct immunofluorescence staining reveals igG and complement C3 deposits in lesional and paralesional skin within the intercellular substance of the epidermis Serum - Autoantibodies IgG present ○ Desmosomes hold epidermal cells together ○ Circulating igG bidns to epidermal desmosomes ○ IgG interferes with desmosomes inducing acantholysis = loss of intracellular connections Refer to dermatologist - Systemic steroids - Immunosuppressive therapy - Cleansing baths - Close monitoring

a 50 year old male presents to your clinic complaining of a large area of eroding skin to his back. He reports having lesions appear his mouth a few months ago and has been having a hard time eating and swallowing. On physical exam you note a large area of erythematous erosions with some crust, as well as discrete, flaccid vesicles and bullae with serous fluid to his shoulders. Pt also has a positive Niklosky sign. What is the diagnosis? What diagnostic tests should you order for this patient? What is the pathophysiology for this disease? What do you recommend as treatment?

Shingles, Varicella Zoster **treatment should be instituted within 72 hours of onset to reduce severity and duration of post-therapudic neuralgia - acyclovir, valcyclovir, famiciclovir DO NOT USE oral corticosteroids - Should fully resolve in 2-3 weeks and monitor patient for worsening or persistent fever (concern for secondary infection). -Advise mother that pt is contagious while vesicles are present and the fluid is vesicles is contagious. **if pt was >50 years old recommend Varicella Zoster Vaccine FYI - burning, ithcing and pain usually occur 2 DAYS before rash, some patients develop chronic neurological symptoms FYI- pts often have systemic viral symptoms and regional lymphadenopathy

a 6-year-old child with leukemia develops a very painful vesicular rash on his abdomen and back. This is the only dermatologic manifestation but is accompanied by fever and malaise. His medical history is significant for leukemia, tonsillectomy, and adenoidectomy at age 3 and chicken pox 4 months later. He has had all his other childhood immunizations. Physical exam reveals a maculopapular rash in a dermatomal distribution on the left flank and extending into the back. Tzanck prep is positive for multinucleated giant cells. What is the diagnosis? What do you recommend as treatment? How should you counsel your pt and parent on the course of the disease?

Molluscum Contagiosum No treatment recommended, the disease is self limitihng CAN be treated with curettage, cryosurgery (similar to warts) for cosmetic purposes **educate mother that erythematous halo = regression

a 6-year-old male who is brought to the clinic by his mother complaining of a rash. On physical exam, you observe dozens of discrete 5-15 mm, pink, flesh-colored, waxy, dome-shaped, umbilicated pearly papules with central umbilication on the lower abdomen and genital area. What is the diagnosis? What would you recommend as treatment?

Cellulitis MSSA- Cephalexin, Dicloxacin MRSA- Clindamycin, Vancomycin, Bactrim

a 64-year-old female presents with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12 cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque. What is the diagnosis? what is the first line of treatment for mild cellulitis (MSSA) for MRSA?

Seborrheic dermatitis Cryotherapy or cutterage Let patient know that this disease is completely benign

a 67 year old male concerned about skin cancer presents to your clinic. Over the past few years, several greasy moles have cropped up on his back. His wife had died of melanoma and now he is scared that these moles are melanomas. On exam, you note several small grey brown and black papules/plaques with a velvety warty texture and a greasy "stuck on" appearance. What is the diagnosis? what do you recommend as treatment?? How can you counsel this patient about his risk of cancer?

Bullous Pemphigoid Systemic + localized steroids IV immunoglobulins Methotrexate

a 75-year-old female who presents to the clinic with a large number of pruritic, tense, subepidermal bullae across her upper thighs. There was no mucosal involvement and skin biopsy showed subepidermal bullae filled with eosinophils and neutrophils. What is the disease? What do you recommend as treatment?

Psoriasis 1st line of treatment - topical steroids Plaque type - majority of patients, lesions present from months to years Eruptive or Guttate

a 75-year-old female with patches of chronic, inflammatory, well-demarcated, erythematous, silvery scaly plaques which involves the scalp and extensor surfaces. What is the diagnosis? What do you recommend as treatment? what are the most commonly seen forms of this disease?

Lice, Pediculosis Capitis Topical permethrin

a 9-year-old girl who is brought in by her mom who noticed the child scratching her head at school pickup. She reports that this itchiness has gone on for around 1 week now. Her mom reports angrily that the school just notified them that several children had lice. Physical exam reveals several ovoid, grayish white eggs < 1 cm away from the base of the hair shaft at the back of the head and behind the ears. What is the diagnosis? What would you recommend as treatment?

Verruca Vulgaris and Verruca Pedis Patient applied treatments - Imiquid cream or podophylox solution Clinically applied- cryotherapy, podophyllin, surgical removal, electrodesiccation ** all warts should be removed they are precancerous

a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her best friend will no longer hold her hand and refuses to come to her house for a sleepover. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet. What is the diagnosis? what do you recommend as treatment?

Tzank smear, viral culture, antibody testing for IgG (shows infection at some point in time but may not indicate active infection) HSV1 Since it is a recurrent infection- Valacyclovir and famiciclovir every day If it was a primary infection- Acyclovir, valacyclovir, famiciclovir x 1 week

a 9-year-old girl with painful skin lesions on the right side of her upper lip, extending onto her nose. The lesions appeared 3 days ago at the vermilion border of her lip. The first manifestation was a pink papule with associated tingling and burning, which evolved into a cluster of small, clear fluid-filled vesicles. Now the vesicles have extended onto her nose. The rash was accompanied by low-grade fever. Her parents report that she has had blisters on her lip twice before but they always resolved in a few days without spreading beyond her lip. What tests would you use to make your diagnosis? What is the diagnosis? What would you recommend as treatment?

Urticaria First line of treatment - 2nd generation Antihistamine HI blockers; Loratadine, cetirizine, fexofenadine other - 1st generation Antihistamine HI blocker- diphenhydramine, hydroxyzine Steroids, Montelukast, Cyclosporine are adjunct treatment options

a well-appearing 9-month-old male with a rash that comes and goes. According to the mother, citrus was recently added to the patient's diet. On physical exam, you observe a widespread rash composed of blanchable, edematous, pink, papules and wheels on the face, trunk, and lower extremities. What is the diagnosis? What do you recommend as treatment?

Scabies Permethrin to the entire body for 8-14 hours before washing off Oral ivermectin

an 11-year-old male complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend who he had a sleepover with this past weekend is also having similar symptoms. What is the diagnosis? What do you recommend as treatment for this patient? What would you recommend as treatment in a severe case?

Stage 3 Remove pressure Debride necrotic tissue Culture would and prescribe abx Maintain moist wound bed with proper care

an 80-year-old bed-bound woman with a temperature of 104°F who you are called to see in the nursing home. The patient is disoriented and confused. On physical examination, the patient's blood pressure is 110/ 80 mm Hg, and her pulse is 72 beats/ minute and regular. There is an 8 × 5-cm pressure ulcer over her sacrum. You see full thickness skin loss and adipose tissue is visual. Also, there is a purulent, foul-smelling discharge coming from the ulcer. How would you stage this ulcer? What would you recommend as treatment?