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Identification and Treatment of Common Rashes in Primary Care Rex Largen, MD BRYAN HEALTH PRIMARY CARE CONFERENCE I have no financial disclosures or conflicts of interest to report. BRYAN HEALTH PRIMARY CARE CONFERENCE

Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

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Page 1: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

Identification and Treatment of Common Rashes in Primary CareRex Largen, MD

BRYAN  HEALTH

PRIMARY  CARE  CONFERENCE

I have no financial disclosures or conflicts 

of interest to report. 

BRYAN  HEALTH

PRIMARY  CARE  CONFERENCE

Page 2: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,
Page 3: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to confirm the diagnosis?A. Bacterial culture

B. Direct fluorescent antibody

C. Fungal culture

D. Potassium hydroxide (KOH) exam

What is the diagnosis?A. Psoriasis

B. Tinea Corporis

C. Pityriasis Rosea

D. Secondary Syphilis

Page 4: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to treat this rash?A. Topical Clotrimazole

B. Topical Terbinafine

C. Oral Terbinafine

D. Oral Fluconazole

Page 5: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the diagnosis?A. Psoriasis

B. Tinea Corporis

C. Pityriasis Rosea

D. Secondary Syphilis

Page 6: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to treat this rash?A. Observation

B. Topical Triamcinolone Cream

C. Prednisone

D. Sunlight

E. All of the Above

Page 7: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

Case 3: History

Page 8: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the diagnosis?A. Guttate Psoriasis

B. Tinea Corporis

C. Pityriasis Rosea

D. Secondary Syphilis

What is the best way to treat this rash?A. Topical Fluocinonide Cream

B. Prednisone

C. Ultraviolet B light

D. Oral antibiotic 

Page 9: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

Case 4: History

Page 10: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the diagnosis?A. Guttate Psoriasis

B. Tinea Corporis

C. Pityriasis Rosea

D. Secondary Syphilis

E. Nummular Dermatitis

Page 11: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to treat this rash?A. Topical Fluocinonide Cream

B. Prednisone

C. Ultraviolet B light

D. Oral antibiotic 

E. IM Kenalog

Case 5: History

Page 12: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What type of drug reaction is this?A. Drug‐induced Hypersensitivity Reaction

B. Exanthematous

C. Fixed Drug Eruption

D. Stevens‐Johnson Syndrome

E. Vasculitis

Page 13: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to treat this rash?A. Reassurance

B. Topical Corticosteroids

C. Oral Antihistamines

D. All of the Above

Case 6: History

Page 14: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the likely diagnosis?A. Bullous Pemphigoid

B. Erythema Migrans

C. Fixed Drug Eruption

D. Spider Bite

E. Vasculitis

Page 15: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the best way to treat this eruption?

A. Stop Offending Drug

B. Potent Topical Corticosteroid

C. Prednisone

D. A and B

Page 16: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

Case 7: History

HPI:Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly, papular eruption involving the skin around her nose and mouth. A friend gave her some fluocinonide cream which initially helped but the rash has now progressed. 

Page 17: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

What is the likely diagnosis?A. Impetigo

B. Cutaneous Candidiasis

C. Perioral Dermatitis

D. Herpes Simplex

What is the best way to treat this eruption?

A. Discontinue Fluocinonide Cream

B. Doxycycline

C. Prednisone

D. Metronidazole Cream

E. A, B, and D

Page 18: Identification and Treatment of Common Rashes in Primary Care · 2018-05-06 · Case 7: History HPI: Ms. Smith is a 27 year‐old white woman with a 6 month history of a red, scaly,

Thank you‐

Questions? Rex Largen, MD

BRYAN  HEALTH

PRIMARY  CARE  CONFERENCE