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The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
1. This patient presents with extensive cutaneous and mucous membrane disease. The correct diagnosis is:
a) Bazex syndrome
b) Reactive arthritis
c) Psoriasis
d) Chronic mucocutaneous candidiasis
e) Acrodermatitis continua of Hallopeau
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1. This patient presents with extensive cutaneous and mucous membrane disease. The correct diagnosis is:
d) Chronic mucocutaneous candidiasis
The patient is diagnosed with chronic mucocutaneous candidiasis. This infection usually occurs in immunosuppressed individuals and often begins in childhood. As the name suggests, oral involvement is a characteristic component. Although systemic azole therapy is effective, regular recurrences are typical. Bazex syndrome, reactive arthritis, and acrodermatitis continua of Hallopeau do not affect the mucous membranes. Psoriasis, even the erythrodermic variety, does not usually involve the oral cavity. Glucagonoma syndrome, acrodermatitis enterpathica, and zinc deficiency are included in the differential diagnosis.
Reference
Plantinga TS, Johnson MD, Scott WK, et al. Human genetic susceptibility to Candida infections. Med Mycol. 2012;50(8):785-794. doi:10.3109/13693786.2012.690902
Click "Next" for question #2!
The contents of these questions are taken from the Galderma Pre-Board Webinar. The Pre-Board Webinar is now an online course. For details, go to https://www.galdermausa.com/Our-Commitment/PreBoard-Webinar.aspx.
2. This patient claimed that her “leopard spots” developed in her late teens. She is scheduled for technetium scanning to detect possible bone involvement. The clinical sign evoked at the bedside by the dermatologist is called:
a) Darier sign
b) Hutchinson sign
c) Nikolsky sign
d) “Oil drop” sign
e) Gottron sign
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2. This patient claimed that her “leopard spots” developed in her late teens. She is scheduled for technetium scanning to detect possible bone involvement. The clinical sign evoked at the bedside by the dermatologist is called:
a) Darier sign
Typical red-brown hyperpigmented macules and papules of mastocytosis often urticate when stroked (Darier sign). Skeletal involvement may occur in approximately 1% of children. In adults with systemic mastocytosis, bone marrow involvement is found in 90%, whereas radiographic evidence of bone involvement is present in only 70% of cases. Since an x-ray skeletal survey may be insufficient in excluding bone involvement, technetium scanning, which is more sensitive in detecting bone involvement, may be employed. Bone changes may be osteosclerotic due to mast cell infiltration or osteoporotic due to malabsorption of vitamin D and calcium. Heparin may also be a factor in osteoporosis. Osteoporotic lesions are generalized in the skull, vertebrae, and ribs. Hutchinson sign is pigmentation of the proximal nail fold in malignant melanoma. Nikolsky sign is frictional separation of the epidermis in bullous disorders, particularly pemphigus vulgaris. The “oil drop” sign is discoloration of the nail bed at the proximal edge of onycholysis in patients with nail psoriasis, and Gottron sign is due to papules usually located over the interphalangeal joints of the hands in patients with dermatomyositis. Urticaria pigmentosa and telangiectasia macularis eruptiva perstans are included in the mastocytosis spectrum.
References
Cheng YP, Hsiao CH, Dai YS. Nevoid urticaria pigmentosa along Blascho’s line. J Dermatol. 2012;39(7):665-666. doi:10.1111/j.1346-8138.2011.01467.x
Mitsuya J, Hara H, Fukuda N, Terui T. A case of cutaneous mastocytosis in a child with prominent Langerhans cell infiltration. Pediatr Dermatol. 2011;28(4):412-415. doi:10.1111/j.1525-1470.2010.01205.x
