Dermatology OSCE Review
Case 1
2 year old / M
What should you ask in Hx? 2 Ddx? defend! Viral? Bacterial? Pathogen? Future Complications? Treatment? Patient Education
feedback
Impetigo Contagiosa
Clinical Presentation: early childhood, but may occur in all ages
Predeliction sites: Exposed body parts (face hands, neck and extremities)
Lesion start as 2mm erythematous macules thin walled vesicles or bullae pustules, which ruptured producing a this straw-colored seropurulent discharge. This discharge dries to form stratified honey-colored or golden brown crust
Impetigo Contagiosa
Can also spread to different parts of the body by sharing of towels
Gyrate patterns are produced as lesions spread peripherally and the skin clears centrally
Impetigo Contagiosa
Differentials
Childhood atopic dermatitis▪ less exudative, drier, more papular▪ Locations – antecubital and popliteal fossa,
flexor wrists, eyelids, face and around the neck.
Impetigo Contagiosa
Source of infection: pets, dirty fingernails, other children with skin lesions, daycare, crowded housing.
Complication: Acute GN (Group A beta- hemolytic streptococcus
Pathogen: Group A Streptococcus –usualComplication: Acute GN (Group A beta- hemolytic
streptococcusTreatment: Systemic antibiotics – Clozacillin; 1st generation
cephalosporin (Cefalexin)Topical: Mupirocin
Prophylaxis – Mupirocin ointment to anterios nares BID Rifampicin 600mg OD x 5 days
Case 225/M with a 6 mon Hx of itchy red lesions on both hands. He had a Brake up with her GF a week before the onset of his complaint. In order to win her GF back he worked in a mining company in w/c He noted hypersensitivity to certain metals. PE e/n except for Derma complaint
Describe?PWI?DifferentialsEtiologyTreatment
Dyshidrotic Eczema/pompholyx Present with deep-seated tapioca-like vesicular
eruption of the palms and soles characterized by eczematous weeping patches containing intraepidermal vesicles
Burning and itching Predeliction sites: fingers, toes, frequently
bilateral symmetrical Bullae may occasionally be found Contents are clear and colorless but may be
straw colored May become secondarily infected Condition may be chronic and relpsing
Dyshidrotic Eczema/pompholyx Etiology – ideopathic Major triggers – stress, atopy, contactantsDifferentials
Contact dermatitis – lesions are more eczematous and are prominent on the dorsal aspect of the hands and feet, there is a history of contactant
Drug eruptions – there is a previous history of drug intake, lesions are located predominantly on the palms and less likely confined to the lateral aspect of the digits
Pustular psoriasis – no fever with sudden appearance of cutaenous lesions
Dyshidrotic Eczema/pompholyx
Treatment: Superpotent and potent topical steroids
– initial therapy Systemic corticosteroids Others – phototherapy, radiation
therapy, and systemic immunosuppressive therapy
Case 3
Ryan 13/MPayatas, RC,Right handed
Describe the lesions.Differentials?More questions?
As a GP in Payatas, what practicalTest can you do to confirm your diagnosis ?
Treatment?
Scabies
Pruritic erythematous papules which may or may not have a 0.5 – 1 cm linear wavy burrows, distributed in areas that are soft, warm and moist: interdigital area, wrist, armpit, inframammary area, umbilical area, inner thigh, scrotal, and buttocks area
Secondary pustules, nodules and excoriations may appear due to chronic rubbing and scratching. Children may be affected in face palms and soles.
Pruritus is worse at night
Scabies
Etiology – Sarcoptes scabie var hominis – found in human skin
Transmitted from person to person by skin contact and is highly contagious. Family might be affected.
Course and prognosis: resolve after therapy Pruritus – may persist for several weeks
after treatment since hypersensitivity to mite segments that have remained in the skin.
Scabies
Treatment and management Single application of permithrin 5% lotion – neck
down – washed off after 8-12 hours Alternatives – Crotamiton 10% lotion to entire
body neck down for 3-5 days Sulfur 2-10 in petrolatum OD washed off after 24
hours for 3-5 days\secondary bacterial infection should be treated with oral antibiotics or mupirocin
Topical mild glucocorticosteriods Sedating antihistamine at night to prevent
trauma in ithcing.
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