Case 2: Non-Scaly Plaques. David, Hannah; David, Hazel; De Guzman, Jan;. De Guzman, Raquel; De Leon, . Gemma. ; . De Mesa, Monique & De Vera, Jestha. 1. 27 y/o call center agent. 2. NON- SCALY PLAQUES. ID: 502059
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DermatologyCase 2: Non-Scaly Plaques
David, Hannah; David, Hazel; De Guzman, Jan; De Guzman, Raquel; De Leon, Gemma; De Mesa, Monique & De Vera, Jestha
27 y/o call center agent
NON- SCALY PLAQUES
ErysipelasCellulitisUrticariaErythema MultiformeExfoliative DermatitisHansen’s Disease
Patient’s FeaturesErysipelasCellulitis Etiologytrimethoprim- sulfamethoxazole medicationbeta hemolytic group A Streptococcal (Occ. GBS)Streptococcus pyogenes, Staphylococcus aureusEpidemiology Age: 27 yoSex: FNewbornPostpartum womenPatients with breaks in the skinHigh risk in immunocompromi-sed patients and in childrenCourseAcute; few hours after intake of drugsAcuteAcuteProdromes Malaise for several hours, chills, high fever, headache, vomiting, and joint painsMalaise, chills, fever
Patient’s FeaturesErysipelasCellulitisEruptionGeneralized Palms and lip mucosa Face and legsBegins in the cheeck near the nose or in front of the lobe of the ear and spreads upward to the scalpLocal erythemaTinea pedis-most common portal of entry
Patient’s FeaturesAcute UrticariaErythema Multiforme
Typical Lesionsred papules with dusky centers.Ulcers in the lip mucosaMay vary from transient hyperemia followed by slight desquamation to intense inflam.Erythematous patch with peripheral extensionScarlet, hot to touch, brawny,swollenRaised and sharply demarcated.Erythema rapidly becomes intense and spreadsArea becomes infiltratedPits on pressureCentral part becomes nodular and surmounted by a vesicle that ruptures and discharges pus and necrotic material
ComplicationsSepticemiaDeep cellulititsLymphangitisGangreneMetastatic abscessSepsis
Patient’s FeaturesAcute UrticariaErythema Multiforme
Patient’s FeaturesAcute UrticariaErythema Multiforme Etiologytrimethoprim- sulfamethoxazole medicationDrugs, food, infectionsUsually non-drug causes, most commonly Herpes Simplex infectionEpidemiology Age: 27 yoSex: FIn young adultsRecurrent episodes more prevalent in femalesYoung adlultsCourseAcute; few hours after intake of drugsAcute; may recur; evolves over days to weeksAcute, self-limited recurrentProdromes Absent to moderate
Patient’s FeaturesAcute UrticariaErythema MultiformeEruptionGeneralized Palms and lip mucosa May be localized or generalized (more common); usually favors covered areas e.g. trunk, buttocks or chestDisseminated; symmetrically and acrally on extremities, facedorsal hands (initially); dorsal feet, extensor limbs, elbows and knees, palms and solesTypical Lesionsred papules with dusky centers.Ulcers in the lip mucosaWheals, white or red evanescent plaques, generally surrounded by a red halo or flare.Erythematous macules raised edematous papules over 24-28 hrs.Classic “target” or “iris” lesions
Patient’s FeaturesAcute UrticariaErythema MultiformeOther Clinical FeaturesSubcutaneous swellings (angioedema), especially of eyelids or lips.Angiodema of GI and respi tracts- abdominal pan, coryza, asthma and respi problems.Involvement of oral mucosa (frequent, mild)No internal organ involvement
Patient’s FeaturesFixed Drug EruptionEtiologytrimethoprim- sulfamethoxazole medicationDrugsMost common cause:Trimethoprim-sulfamethoxazoleEpidemiology Age: 27 yoSex: FAge: (1.5-81 y/o)F: 31 y/oM: 30 y/oM:F = 1:1.1CourseAcute; few hours after intake of drugsDevelops over a period of hours, may persist from days to weeks and then fade slowly to residual oval hyperpigmented patches Prodromes
Patient’s FeaturesFixed Drug EruptionEruptionGeneralized Palms and lip mucosa mostly </6 lesions >/1 cm in diameter frequently located on the lip or genitaliaTypical Lesionsred papules with dusky centers.Ulcers in the lip mucosa Begins as a red patch evolves into an iris or target lesion (dusky center) and may eventually blister and erode
Patient’s FeaturesFixed Drug EruptionOther Clinical Featuresnormally resolve w/ hyperpigmentation and may recur at the same site with reexposure to the drug
Fixed Drug Eruption
DIAGNOSIS: Fixed Drug Eruption
exact mechanism is unknowncell-mediated process that initiates both the active and quiescent lesions. may involve an antibody-dependent, cell-mediated cytotoxic response.CD8+ effector/memory T cells play an important role in reactivation of lesions with re-exposure to the offending drug.
relies on the principle of a type IV (delayed) hypersenstitivity reactionmust be performed on a previously involved sitecomprises a series of small, aluminium wells containing various concentrations of the offending medication mounted on hypoallergenic tape
standard occlusion time : 48 h
first reading: day 2 generally 15-30 min after patch removal second reading: day 3 or 4Results are recorded using a standardized scoring system
check for cross-sensitivities to medications*A refractory period has been reported in fixed drug eruption; therefore, a delay before and between patch testing and oral provocation is recommended
Acute interface dermatitis with prominent
change and individual necrotic keratinocytes within the epidermis (X10).
Interface dermatitis, vacuolar change, necrotic keratinocytes, and incontinent pigment in the dermis (X40).
Diagnostic procedure of choiceGenerally performed during the acute stage of recurrence
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