A 14-year-old female patient presents to your family practice clinic having received a 1% total body surface area first and second degree burn to the left forearm. Of the following, what would you recommend for your patient?
A. Deroof any blisters, apply bacitracin topically, and prescribe pain medication, with follow-up in 48 hours,
B. Deroof any blisters, apply silver sulfadiazine topically, and prescribe pain medication, with follow-up in 48 hours.
C. Leave any blisters intact, apply bacitracin topically, and prescribe pain medication, with follow-up in 48 hours.
Which of the following concerning changes in nevi can be associated with melanoma?
A. asymmetry, irregular borders, color changes, and growth of the lesion
B. asymmetry, enlarged border, color uniformity, diameter <4mm
C. asymmetry, bleeding, color uniformity, diameter <4mm
D. symmetry, well defined borders, color irregularity, diameter <4mm
The answer is A.
EXPLANATION: Hidradenitis suppurtiva affects females more than males, and may show a family history of nodulocystic acne and/or hidradenitis suppurtiva. Skin lesions are usually tender nodules and abscesses that may spontaneously drain. Open comedones, including double comedones, are common. Eventually, sinus tracts may form. Nodulocystic acne consists of nodules and cysts, ranging in size from 1 to 4 cm in diameter. These lesions are distributed on the face, back, and chest. Acanthosis nigricans is described as a velvety, hyperpigmented plaque distributed around the neck, in the axillae, and in the groin. MRSA can have several different presentations, ranging from erythrasma to the presence of papules and pustules. Comedones are not associated with MRSA.
A 22-year old female presents to your office complaining of itchy red welts all over her body now fading. She is vacationing from Florida. She has no past medical history and her only medication is an oral contraceptive, but she did take an over-the-counter dipenhydramine four days ago on the flight from Florida to calm her nerves. The welts began after swimming in the ocean in New England three days ago, lasted a few hours, then disappeared spontaneously. They reoccurred Saturday morning again shortly after swimming, lasted a little longer, and again resolved. She relates that they were intensely itchy, red, and raised. She ate out at a restaurant and had seafood Saturday night, and thought that she might be allergic to the seafood, although she ate nothing new or unusual. From the history, which of the following is the likely cause of her urticaria?
A. atopic dermatitis
B. cold urticaria
C. contact dermatitis from jellyfish stings
D. food allergy
The answer is B.
EXPLANATION: Cold urticaria is a hypersensitivity to cold exposure (ie, wind, freezer compartments, water) resulting in histamine release. The hypersensitivity usually presents as localized redness, burning, pruritus, and urticaria in the exposed areas, or the response may progress to generalized systemic reaction, shock, and death. This condition may be familial or acquired. Familial cold urticaria is an autosomal dominant inflammatory disorder (including the Muckle-Wells syndrome), manifested as a burning sensation of the skin occurring about 30 minutes after exposure to cold. Acquired cold urticaria may be associated with medication (ie, griseofulvin) or with infection. Cold urticaria may occur secondarily to cryoglobulinemia or as a complication of syphilis. Most cases of acquired cold urticaria are idiopathic. For diagnosis, an ice cube is usually applied to the skin of the forearm for 4 to 5 minutes, then removed, and the area is observed for 10 minutes. As the skin rewarms, an urticarial wheal appears at the site that may be accompanied by itching.
Second-generation antihistamines have been used as first-line treatment. Ebastine is also reported to safely and effectively prevent symptoms from acquired cold urticaria. Use of antileukotrienes in cold urticaria is anecdotal.