Scaly plaques spread from head to toe by ProQuest


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    CME Dermatology Clinic
     CE                                ■ LEARNING OBJECTIVES: To increase awareness of dermatologic conditions, their
                                         diagnosis, and up-to-date treatment.
                                       ■ COMPLETE THE POSTTEST: Page 58        ■ ADDITIONAL CME/CE: Pages 21, 55

  CASE #1

Scaly plaques spread
from head to toe
A 33-year-old Caucasian man presented with an 11-month history of
an erythematous, pruritic, scaly rash that began on the scalp and spread
to the rest of the body. The patient previously failed five months of
treatment with oral and topical corticosteroids as well as antibiotics.
The patient was generally healthy with a history of hypertension,
asthma, and neuropathy secondary to a shoulder injury. Medications
on presentation included a fluticasone/salmeterol inhaler, an albuterol
inhaler, and lisinopril. He had no known drug allergies.

What is your diagnosis? Turn to page 44

                                                          CASE #2

                                                        Rash preceded by
                                                        fever and cough
                                                        BY CRAIG G. BURKHART, MD, MPH
                                                        A child aged 23 months was admitted to the hospital with a four-day
                                                        history of a high fever, cough, and conjunctivitis of unknown origin
                                                        prior to the onset of an extensive, maculopapular rash. Neither the
                                                        mother nor the father in this one-child family had any symptoms
                                                        or rash. The young girl had no known exposures to anyone with a
                                                        viral disease; however, she frequently accompanied her mother to
                                                        the airport to pick up and drop off her father. After admission, the
                                                        patient was placed on prophylactic oral antibiotics. When examined
                                                        on her second hospital day, the child’s fever was waning while the
                                                        rash was worsening.

                                                        What is your diagnosis? Turn to page 45

                                                   • THE CLINICAL ADVISOR • JUNE 2010 43
                               CE          Dermatology Clinic
  CASE #1          Pemphigus foliaceus                          are rarely involved in PF, unlike PV.3 The most common
                                                                age of onset for PF is between 50 and 60 years. 3 Unlike
                               Phy s ic a l ex a m showe d      PV, PF is not seen more commonly in Jews or in people
                               thickened, gray plaques on       of Mediterranean descent. 3 PF sometimes develops in
                               the scalp and erythematous,      patients with PV and, more rarely, PV has been shown
                               hyperkeratotic plaques on the    to develop in patients with PF.4
                               cheeks, trunk, genitals, and       PF is seen throughout the world but has an endemic
                               bilateral lower extremities      form known as Fog
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