Lichenoid eruptions

DescriptionFlat-topped, polygonal, violaceous papules and

plaquesWickham’s striae: fine lacy patternDorsal surface of extremitiesKoebner phenomenon at sites of traumaNail dystrophyOral mucosa: lacy white plaques

Lichen Planus

TreatmentTopical steroids

CourseProlonged period of

hyperpigmentation can be expected

Lichen Planus

DescriptionFlat-topped papules appear abruptlyErythematous or hypopigmented

Surfaces with fine scaleLinear or swirled distribution

(along skin lines of Blaschko)Nail dystrophy

LocationExtremeties, neck, upper back

Lichen Striatus

TimingPeak in school-age children

CourseSpontaneous resolution 1-2yrs

Lichen Striatus

Vesiculopustular disorders

Tells you that it’s a viral lesionMultinucleated giant

cellNot specific to type of

virusOutdatedUse DFA, PCR, or Viral

culture

Tzanck Smear

Superficial bacterial skin infection

Cause: GAS, GBS, S.aureusLocation

Tips of pads of fingers/toesDescription

Tense blisters, 5-10mmFilled with thin, purulent

fluidNarrow erythematous rimThick crust upon rupture

Blistering Distal Dactylitis

Which is true of the condition pictured?A Use of systemic steroids

may improve survivalB Systemic antibiotics with

G+ coverage are the mainstay of treatment

C Permanent sequelae may include visual impairment

D Nikolsky’s sign is negative

Question 3

Reactive erythemas

Description 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

Erythema Nodosum

Timing/Course>10y/oLasts 2-6wksOften recurs

DescriptionRed, tender, slightly elevated

nodules Indurated SQ plaquesBrownish-red or purplish-red hueShins most common site

TreatmentTx underlying causePain: NSAIDS and rest

Erythema Nodosum

Aka “Hives” “Welts”Course

Sudden onsetTransientLasts 1-24hrs

DescriptionWell-demarcated intensely pruriticAppear to migrateMay coalesceWhite/red “halo”

Urticaria

Cause: can be IgE or complement mediatedAcute (<6wks)

IgEAcute infections (strep, mono)FoodsDrugsInsect bitesContact or inhaled allergen

Chronic (>6wks)Occult infectionHep BConnective tissue dz

Urticaria

This child has mild edema of hand/feet and painful migratory periarticular swelling of wrists and ankles. The most likely etiology is:

Question 4

A Staph Scalded Skin SyndromeB Henoch-Schonlein PurpuraC Hemolytic Uremic SyndromeD Interstitial nephritis as part of a reaction to medicationsE Serum Sickness-Like Reaction

Type III reaction: Immune-Complex DepositionSymptoms

Urticarial lesionsRelatively nonpruriticTarget or serpiginous

Periarticular swellingMigratory

Stocking-glove angioedemaPainful

Facial edemaFever

Serum Sickness-Like Reaction

TriggersURIMeds

SulfaCefaclorMinocyclinePCN

CourseWax and wane over 1-3wks

Serum Sickness-Like Reaction

Hypersensitivity syndromeCauses

Drugs, viruses, bacteria, foods, immunizations

Connective tissue dzRecurrent EM

Recurrent HSV infxnLocation

Any part of bodyCommonly: palms/soles,

arms/legs

Erythema Multiforme

DescriptionSymmetricalDusky red macules – evolve into iris or target-

shaped lesionsCenter of target may be blue, violaceous, or

whiteVescicles or bullae may develop

Center or ring of targetMay appear as diffuse urticaria initiallyNon-pruritic, may be painful

Erythema Multiforme

CourseCrops last 1-3 wksSelf limited?Mild systemic symptoms?

Low grade feverMalaiseMyalgia

Mucous membranes sparedOr mildly involved

Erythema Multiforme

Epidermal and mucous membrane necrosis and sloughingCleavage beneath basment membrane zoneFull-thickness sloughing

SJS: <30% BSATEN: >30% BSACause: hypersensitivity, viral infxn,

connective tissue dz, malignancy

SJS / TEN

Ophtho:Corneal scarringLid scarring: ectropion

FENDehydrationMalnutritionElectrolyte imbalance

IDSuperficial infectionSepsis

Death

SJS/TEN Complications

TreatmentIVIGSteroids relatively contraindicated

GI symptomsImmune suppression

Differentiate from SSSSSSSS

Bullae more thin-walledMucous membranes red, but do not slough

SJS / TEN

75% of all cutaneous drug reactionsDescription

Erythematous macules and papulesRange from fine to blotchyEruption 5-14days after starting medFace/Trunk extremitiesMay become confluentResolves over 1-2 wksMay see mild purpura, desquamation

Morbilliform Drug Eruption

Recur at same localized site following reexposure to offending drug

Target and bullous lesionsResemble erythema multiforme

Morphologically and histologically(only localized)

Fixed drug eruption

Vasculitis

Classic TetradPalpable purpura

Without thrombocytopenia or coagulopathyPresent in almost all patients

Arthritis/Arthralgia75%

Abdominal Pain (May have hematochezia)50%Intussussception (ileo-ileal)

Renal Disease (Mild)21-54%

Not all symptoms must be present for diagnosisTakes days to weeks to developMay present as abd pain or joint complaints*May recur

Henoch-Schonlein Purpura

Diffuse VasculitisHisto:

immune-complex deposition in capillariesLeukocytic vasculitis in skin

TreatmentSupportiveMay use steroids if severe

Henoch-Schonlein Purpura

DIFFERENTIATE FROM HUSHemolytic Uremic Syndrome

More toxicRenal involvement more severe (dialysis)Hemolytic: anemia, thrombocytopeniaMore severe neuro manifestations

Henoch-Schonlein Purpura