Dermatology

Question 1

What is acquired perforating keratosis (Kyrle disease)? and with what condition is related?

Answer 1

• Dome-shaped and umbilicated papules with a central keratotic crust on legs or less often trunk, neck, arms or scalp. Early lesions→pustular. Late lesions→resemble prurigo nodularis (central keratotic scale)
• Chronic renal failure and Diabetes mellitus

Question 2

Two major exposure associations of Squamous cell carcinoma. How do you call an SCC arising from a burn wound?

Answer 2

• Ultraviolet sun exposure
• Chronically wounded, scarred, or inflamed skin
• Marjolin Ulcer

*Within skin overlying a focus of osteomyelitis, radiotherapy scars, venous ulcers

Question 3

Describe the clinical presentation and lesions of pityriasis rosea

Answer 3

• Viral prodrome: headache, malaise, fever.
• Lesions: First herald patch→erythematous annular lesion, scaly around edge. In 1 week→clusters of small, scaly, erythematous oval lesions on the trunk in “christhmas tree” pattern (back). Mild pruritus.

Question 4

Treatment for papulopustular rosacea

Answer 4

• First line: Topical metronidazole, azelaic acid, ivermectin
• Severe or refractory cases: oral tetracyclines (doxycycline, tetracycline)

Question 5

Treatment for Alopecia areata

Answer 5

• Mild/moderate hair loss: topical or intralesional corticosteroids
• Extensive hair loss: topical immunotherapy (diphenylcyclopropenone), oral corticosteroids

*Autoimmune disorder involving the hair bulb cells

Question 6

Treatment for local psoriasis

Answer 6

• Topical high-potency steroids: fluocinonide, triamcinolone, betamethasone, clobetasol
• Calciprotiene➡vitamin D ointment
• Coal tar preparation
• Pimecrolimus and tacrolimus (alternative to steroids)

Question 7

Treatment for extensive psoriasis

Answer 7

• Ultraviolet light
• Anti-TNF: Etanercept, adalimumab, infliximab
• Methotrexate: last resort except for psoriatic arthritis

Question 8

Treatment of Steven-Johnson syndrome and Toxic epidermal necrolysis (TEN)

Answer 8

Intravenous immunoglobulins (IVIG)

*Steroids do not benefit or do not help