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.