1. Lichenoid eruptions

2. Lichen Planus Description
Flat-topped, polygonal, violaceous papules and plaques
Wickham’s striae: fine lacy pattern
Dorsal surface of extremities
Koebner phenomenon at sites of trauma
Nail dystrophy
Oral mucosa: lacy white plaques

3. Lichen Planus Treatment Course Topical steroids
Prolonged period of hyperpigmentation can be expected

4. Lichen Striatus Description Location
Flat-topped papules appear abruptly
Erythematous or hypopigmented
Surfaces with fine scale
Linear or swirled distribution
(along skin lines of Blaschko)
Nail dystrophy
Location
Extremeties, neck, upper back

5. Lichen Striatus Timing Course Peak in school-age children
Spontaneous resolution 1-2yrs

6. Vesiculopustular disorders

7. Tzanck Smear Tells you that it’s a viral lesion
Multinucleated giant cell
Not specific to type of virus
Outdated
Use DFA, PCR, or Viral culture

8. Blistering Distal Dactylitis
Superficial bacterial skin infection
Cause: GAS, GBS, S.aureus
Location
Tips of pads of fingers/toes
Description
Tense blisters, 5-10mm
Filled with thin, purulent fluid
Narrow erythematous rim
Thick crust upon rupture

9. Question 3 Which is true of the condition pictured?
A Use of systemic steroids may improve survival
B Systemic antibiotics with G+ coverage are the mainstay of treatment
C Permanent sequelae may include visual impairment
D Nikolsky’s sign is negative
Answer: C
TEN

10. Reactive erythemas

11. Erythema Nodosum Description Location
Symmetrical, red, tender nodules
1-5cm
Location
Pretibial
Hypersensitivity reaction, associated with:
Strep
Sarcoid
Ulcerative colitis TB
Other bacterial/fungal infxn
Oral contraceptives and other meds

12. Erythema Nodosum Timing/Course Description Treatment >10y/o
Lasts 2-6wks
Often recurs
Description
Red, tender, slightly elevated nodules
Indurated SQ plaques
Brownish-red or purplish-red hue
Shins most common site
Treatment
Tx underlying cause
Pain: NSAIDS and rest

13. Urticaria Aka “Hives” “Welts” Course Description Sudden onset
Transient
Lasts 1-24hrs
Description
Well-demarcated intensely pruritic
Appear to migrate
May coalesce
White/red “halo”

14. Urticaria Cause: can be IgE or complement mediated Acute (<6wks)
Acute infections (strep, mono)
Foods
Drugs
Insect bites
Contact or inhaled allergen
Chronic (>6wks)
Occult infection
Hep B
Connective tissue dz

15. Question 4
This child has mild edema of hand/feet and painful migratory periarticular swelling of wrists and ankles. The most likely etiology is:
A Staph Scalded Skin Syndrome
B Henoch-Schonlein Purpura
C Hemolytic Uremic Syndrome
D Interstitial nephritis as part of a reaction to medications
E Serum Sickness-Like Reaction
Answer: E

16. Serum Sickness-Like Reaction
Type III reaction: Immune-Complex Deposition
Symptoms
Urticarial lesions
Relatively nonpruritic
Target or serpiginous
Periarticular swelling
Migratory
Stocking-glove angioedema
Painful
Facial edema
Fever

17. Serum Sickness-Like Reaction
Triggers
URI
Meds
Sulfa
Cefaclor
Minocycline
PCN
Course
Wax and wane over 1-3wks

18. Erythema Multiforme Hypersensitivity syndrome Causes Recurrent EM
Drugs, viruses, bacteria, foods, immunizations
Connective tissue dz
Recurrent EM
Recurrent HSV infxn
Location
Any part of body
Commonly: palms/soles, arms/legs

19. Erythema Multiforme Description Symmetrical
Dusky red macules – evolve into iris or target-shaped lesions
Center of target may be blue, violaceous, or white
Vescicles or bullae may develop
Center or ring of target
May appear as diffuse urticaria initially
Non-pruritic, may be painful

20. Erythema Multiforme Course Crops last 1-3 wks Self limited
?Mild systemic symptoms?
Low grade fever
Malaise
Myalgia
Mucous membranes spared
Or mildly involved

21. SJS / TEN Epidermal and mucous membrane necrosis and sloughing
Cleavage beneath basment membrane zone
Full-thickness sloughing
SJS: <30% BSA
TEN: >30% BSA
Cause: hypersensitivity, viral infxn, connective tissue dz, malignancy

22. SJS/TEN Complications
Ophtho:
Corneal scarring
Lid scarring: ectropion
FEN
Dehydration
Malnutrition
Electrolyte imbalance ID
Superficial infection
Sepsis
Death

23. SJS / TEN Treatment Differentiate from SSSS SSSS IVIG
Steroids relatively contraindicated
GI symptoms
Immune suppression
Differentiate from SSSS
SSSS
Bullae more thin-walled
Mucous membranes red, but do not slough

24. Morbilliform Drug Eruption
75% of all cutaneous drug reactions
Description
Erythematous macules and papules
Range from fine to blotchy
Eruption 5-14days after starting med
Face/Trunk  extremities
May become confluent
Resolves over 1-2 wks
May see mild purpura, desquamation

25. Fixed drug eruption
Recur at same localized site following reexposure to offending drug
Target and bullous lesions
Resemble erythema multiforme
Morphologically and histologically
(only localized)

26. Vasculitis

27. Henoch-Schonlein Purpura
Classic Tetrad
Palpable purpura
Without thrombocytopenia or coagulopathy
Present in almost all patients
Arthritis/Arthralgia
75%
Abdominal Pain (May have hematochezia)
50%
Intussussception (ileo-ileal)
Renal Disease (Mild)
21-54%
Not all symptoms must be present for diagnosis
Takes days to weeks to develop
May present as abd pain or joint complaints*
May recur

28. Henoch-Schonlein Purpura
Diffuse Vasculitis
Histo:
immune-complex deposition in capillaries
Leukocytic vasculitis in skin
Treatment
Supportive
May use steroids if severe

29. Henoch-Schonlein Purpura
DIFFERENTIATE FROM HUS
Hemolytic Uremic Syndrome
More toxic
Renal involvement more severe (dialysis)
Hemolytic: anemia, thrombocytopenia
More severe neuro manifestations