1. alegre. almora. alonzo. amaro. amolenda. anacta. andal. ang. ang. ang. Dermatology Case 2:

2. EG 43 y/o F Chief Complaint: Plaques and Nodules on the face, trunk, and extremities

3. HISTORY OF PRESENT ILLNESS 3 8 months PTC 6 month PTC Few erythematous ill-defined asymptomatic patches over both upper extremities -associated tingling sensation and numbness of the hands and forearms No consult was done nor medications taken Few erythematous ill-defined asymptomatic patches over both upper extremities -associated tingling sensation and numbness of the hands and forearms No consult was done nor medications taken Plaques and nodules involving the forehead, malar area, left ear, trunk and extremities CONSULT

4. FAMILY HISTORY (+) HPN, DM (-) similar lesion

5. PHYSICAL EXAMINATION Skin:  multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm over the malar area, helix of ears, upper extremities, thighs (+) leonine facies (-) madarosis

6. CLINICAL IMPRESSION Salient Features  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis Lepromatous type of Leprosy (Hansen’s Disease)

7. DIFFERENTIAL DIAGNOSIS Hansen’s Disease (other types) Erythema multiforme Fixed drug reaction Seborrheic dermatitis Cellulitis Urticaria Exfoliative dermatitis

8. Seborrheic Dermatitis also known as seborrhea common non-contagious condition of skin areas rich in oil glands (the face, scalp, and upper trunk)  marked by flaking (overproduction of skin cells) and sometimes redness and itching (inflammation) of the skin varies in severity from mild dandruff of the scalp to scaly, red patches on the skin.

9. Seborrheic Dermatitis Epidemiology:  with redness and flaking = 3–5% of the population  affects all races; worse in men, and starts after puberty (although babies have a version called cradle cap) and peaks around the age of 40 and then may improve Cause:  due to a combination of an over production of skin oil and irritation from a yeast, Pityrosporum ovale. Risk:  Stress, fatigue, weather extremes, oily skin, infrequent shampoos or skin cleaning, use of lotions that contain alcohol, skin disorders (such as acne), or obesity  Familial

10.  Patient’s Data  EG 43 y/o F  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  EG 43 y/o F  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  Seborrheic Dermatitis  Lesion  Scanty, loose, dry, moist or greasy scales and by crusted pinkish or yellowish patches  Age of Predilection  Starts at puberty and peaks at the age of 40  Signs & Symptoms:  Scalp is itchy and sheds white, oily skin flakes.  In darker skin, some of the affected areas may look lighter in color.  Lesion  Scanty, loose, dry, moist or greasy scales and by crusted pinkish or yellowish patches  Age of Predilection  Starts at puberty and peaks at the age of 40  Signs & Symptoms:  Scalp is itchy and sheds white, oily skin flakes.  In darker skin, some of the affected areas may look lighter in color.

11.  Patient’s Data  EG 43 y/o F  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  EG 43 y/o F  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  Seborrheic Dermatitis  Site of Predilection  Areas has patches of red, scaly skin:  the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit; Flexors of elbow and knee  Classifications  Mild – only some flaking and redness in a few small areas.  Moderate – several areas affected with bothersome redness and itch.  Severe – large areas of redness, severe itch and unresponsive to self-care measures.  Site of Predilection  Areas has patches of red, scaly skin:  the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit; Flexors of elbow and knee  Classifications  Mild – only some flaking and redness in a few small areas.  Moderate – several areas affected with bothersome redness and itch.  Severe – large areas of redness, severe itch and unresponsive to self-care measures.

12. Seborrheic Dermatitis

13. The diagnosis is based on the appearance and location of the skin lesions  In rare cases - skin biopsy to r/o other diseases Therapeutic Plans  Shampoo several times a week  Selenium sulfide, zinc pyrithionate, tar and resorcin shampoos  Topical Antifungals  Ketoconazole 2% cream  Corticosteroid creams

14. (Differential Dignosis) (brief description of pathology) (epidemiology, incidence, etc.)

15.  Patient’s Data  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  (Differential…)  (pertinent data per differential)

16. (Differential Dignosis) (diagnostic evaluation) (therapeutic plans)

17. (Differential Dignosis) (brief description of pathology) (epidemiology, incidence, etc.)

18.  Patient’s Data  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  (Differential…)  (pertinent data per differential)

19. (Differential Dignosis) (diagnostic evaluation) (therapeutic plans)

20. (Differential Dignosis) (brief description of pathology) (epidemiology, incidence, etc.)

21.  Patient’s Data  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  (Differential…)  (pertinent data per differential)

22. (Differential Dignosis) (diagnostic evaluation) (therapeutic plans)

23. (Differential Dignosis) (brief description of pathology) (epidemiology, incidence, etc.)

24.  Patient’s Data  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  erythematous ill-defined asymptomatic patches (upper extremities) into multiple erythematous to skin-colored plaques and nodules 1.5x 3.5 to 2.0 x 4.0 cm (malar area, helix of ears, upper extremities, thighs)  (+) leonine facies  (-) madarosis  (Differential…)  (pertinent data per differential)

25. (Differential Dignosis) (diagnostic evaluation) (therapeutic plans)