Here: Ted Rosen, MD, presents 5 tips about 5 disorders that you might not know.
Sexually active young man presents with acute-onset, painless, non-pruritic facial rash.
Key point: The profusion of plateau-shaped papules on the face, particularly in those with skin of color, is a typical appearance for secondary syphilis.
Treatment: Intramuscular bicillin, 2.4 million units.
Note: Should also test for HIV coinfection.
Patient presents with widespread, almost confluent psoriasis with intense itching.
Key point: Even though about 80% of psoriasis cases can be managed with topical medication, the widespread nature in this case precludes topical therapy.
Treatment: A biologic drug (etanercept, adalimumab, infliximab, or ustekinumab) would be a good choice.
Note: Obesity suggests concomitant metabolic syndrome, and appropriate blood tests (fasting glucose, hemoglobin A1c, triglycerides, cholesterol) should be considered.
Sexually active young man presents with dysuria and profuse purulent urethral discharge.
Key point: Symptomatic, spontaneous purulent discharge is most typical of gonorrhea.
Treatment: Intramuscular ceftriaxone 250 mg PLUS azithromycin or doxycycline.
Note: Ciprofloxacin has recently been dropped as a recommended gonorrhea therapy because of high prevalence rates of resistance.
Patient presents with slowly expanding, asymptomatic, soft, red to red-brown facial plaques. No antecedent trauma and no regional adenopathy. Negative review of systems.
Key point: This is a classic appearance for a rare, benign disorder of unknown etiology called granuloma faciale.
Treatment: Oral dapsone, 100 mg daily, is the treatment of choice.
Note: If medical therapy fails, this lesion often responds to laser treatment (Nd:YAG or pulsed dye lasers).
Patient presents with pruritic scaling of both palms for 8 months. It is getting worse. His feet do not have the same problem.
Key point: This could be tinea manum (dermatophytosis of the hands), palmar psoriasis, chronic contact dermatitis, or hand eczema. A KOH preparation and culture of the scale should be done to look for fungi and a detailed work/hobby history taken to search for repetitive exposure to potent allergens (such as concrete).
Treatment: Topical antifungal of choice or ultrapotent corticosteroid cream, depending on whether fungi are found.
Note: If therapy fails and diagnosis remains uncertain, a punch biopsy would be indicated. Phototherapy would be an alternative for both psoriasis and eczema.