Active Learning Modules Important Dermatology Problems

EXERCISE 1 Clinical Scenario Dermatology Slide 2 EXERCISE 1 Clinical Scenario A 10-year-old boy developed nasal congestion, sore throat, and ear pain while camping with his family along the Appalachian Trail on the Tennessee-North Carolina border 2 weeks ago. He was seen in a walk-in clinic and treated with 10 days of amoxicillin for otitis media. He completed all of his medications and was well until 2 days ago when he developed fever to 39 degrees C and a severe unremitting headache. Yesterday he developed a rash. His exam shows him to be listless. He has no neck stiffness but complains of generalized severe headache.

Target lesions, desquamation and extension to mucous membranes Dermatology Slide 3 EXERCISE 1   Question 1:1 Based on this presentation what is the most likely appearance of the rash?   Target lesions, desquamation and extension to mucous membranes 5–6 cm enlarging annular lesion with central clearing Diffuse maculopapular rash on distal extremities Urticarial appearance with edema of distal extremities Multiple target lesions of varying size

What is the most likely diagnosis? Dermatology Slide 4 EXERCISE 1   Question 1:2 What is the most likely diagnosis?   Erythema multiforme Stevens-Johnson syndrome Serum sickness–like drug reaction Lyme disease Rocky Mountain spotted fever

EXERCISE 2 Clinical Scenario Dermatology Slide 5 EXERCISE 2 Clinical Scenario A 26-year-old African-American mother presents in active labor. She had adequate prenatal care and negative screens for group B strep, Hepatitis B, HIV, rubella, and syphilis. She has a prior history of genital herpes. She is delivered in the ER where she presented fully dilated and crowning after rupture of membranes at home 4 hours prior to delivery. The delivering physician noted some vesicular lesions on the labia. After an unremarkable neonatal course you see the baby back in followup 4 days later and note that the child has multiple white pustules on the forehead and face not previously noted. (See photo.) The child is afebrile, alert, and vigorous at this time.

Dermatology Slide 6

How would you treat this rash? Dermatology Slide 7 EXERCISE 2   Question 2:1 How would you treat this rash?   Intravenous acyclovir Topical ketoconazole Clindamycin Selenium sulfide shampoo No treatment

What is the most likely diagnosis? Dermatology Slide 8 EXERCISE 2   Question 2:2 What is the most likely diagnosis?   Erythema toxicum Herpes neonatorum Milia Pustular melanosis Neonatal cephalic pustulosis

EXERCISE 3 Clinical Scenario Dermatology Slide 9 EXERCISE 3 Clinical Scenario A 6-year-old child was sent home by the school nurse 4 days ago with “ringworm.” The child’s mother applied an OTC antifungal cream as directed by the walk-in clinic physician 3 times daily to the rash but it did not resolve. The mother brings the child in today because there are now many more smaller lesions on the child’s trunk, chest, and back, some of which are slightly itchy. The child was treated 3 weeks ago for sinusitis with cefdinir prescribed by the walk-in clinic physician. This was administered and completed as directed. Exam shows a large annular patch about 5 cm in diameter with an area of central clearing which the mother says was the first skin change noted. There are also multiple flat papules of varied sizes seen on the chest and back. These are slightly red in color with scant fine scale noted at the edges. Larger lesions—about 1 cm—are noted to have some central clearing.

What is the most likely diagnosis? Dermatology Slide 10 EXERCISE 3   Question 3:1 What is the most likely diagnosis?   Nummular eczema Contact dermatitis Pityriasis rosea Morbilliform drug eruption Granuloma annulare