Derma Case: 36-year-old Woman with Eczema

by Stephen Holt, MD, MS

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      Slides Atopic Contact and Seborrheic Dermatitis.pdf
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    00:02 So now we'll review 2 quick cases just to highlight some key points of some of those other things on our list, and then do 2 review questions after that.

    00:11 So, quick case. 36-year-old airforce pilot with a past medical history of childhood asthma, presents with, "My eczema is back." She reports slowly progressive itchy patches on both of her arms over the past month. She remembers having problems with itchy skin when she was younger, but hasn't had issues with this in many years.

    00:32 This is a good example where you could be susceptible to anchoring bias.

    00:35 The patient's telling you what she thinks it is.

    00:39 And the chart, of course, has atopic eczema written all over it when she was a child. We know the patient's allergic to penicillin, allergic to cats.

    00:47 This would also be common for someone with an atopic history to have medication allergies, food allergies, allergies to cat dander.

    00:55 Social family history also atopic. You're really going to get sucked into this anchoring bias trap, if you're not careful.

    01:02 Review of systems is negative. Initial vitals, pretty unremarkable.

    01:06 And on exam, you see erythematous, lichenified plaques -- sounds like eczema -- on the bilateral elbows with silvery scale.

    01:17 Now, that sounds like something else. Let's take a look at our differential diagnosis.

    01:21 Seb derm, kind of the wrong. Age group for seb derm - not a kid, not an elderly patient and we're not told that she's HIV positive.

    01:29 Irritant contact dermatitis and allergic contact dermatitis always worth considering. You have to take a thorough history, look for any changes to any shampoos or clothing or medications or anything that's new. Psoriasis.

    01:43 Again, she's got these silvery plaques on a backdrop of some erythematous plaques.

    01:48 And then atopic dermatitis, we've talked about. This case, I think we can safely say with that silvery scale, again, that's one of those pathognomonic clues that you'll see on the boards. It sounds like this is a case of psoriasis.

    About the Lecture

    The lecture Derma Case: 36-year-old Woman with Eczema by Stephen Holt, MD, MS is from the course Allergic and Immune-mediated Skin Disorders.

    Included Quiz Questions

    1. Plaques with silvery scales
    2. Positive Nikolsky sign
    3. Predilection for flexural surfaces
    4. Papules and pustules with honey-crusted lesions
    5. Onset at age >50 years

    Author of lecture Derma Case: 36-year-old Woman with Eczema

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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