Dermatologist : Q & A


#1

1).Among the following alternatives , which is the most common site of Herpes Gastations?

a.Vulva
b.Infraorbital
c.Flanks of abdomen
d.Perumbilical region

solution:

Pemphigoid gestationis (Herpes gestationis)

The least common,yet best characterized,dermatitis specific to pregnancy is pemphigoid gastationis (PG)

It typically presents as an intensely pruritic,urticarial rash over the course of the later part of pregnancy or the immediate
postpartum period, then quickly advances to a pemphigoid like, vesiculobullous eruption.
The rash may wax and during pregnancy, only to flare during labor and delivery.
The eruption is initially restricated to the periumbilical area with later spread abdomen thighs, palms, and soles in 90%
of patients
The condition usually becomes widespread however, the face and oral mucosa are usally spared.

Management

Oral antihistamines can be used to relieve symptoms.
Topical or oral corticosteroids serve as the management of choice ,usally prednisone20-60mg daily.
cyclosporine and intravenous immunoglobulin have been used in refractory conditions.

Ref: Chapter 59. Pemphigold gestationis (Herpes gestationis). In: Goldsmith LA,Katz SI,gILCHREST BA,Paller AS,Leffell DJ,Wolff K.eds Fitzpatrick’s dermatology
in general medicine 8e.

2). A woman aged 75yrs complains to a physician of facial pain ,headache,and intermittent visual symptoms. Both temporal arteries
are biosied.

Which of the following would be the most probable pathological finding in case the biopsies reveal abnormal vessels?

a.Atherosclerotic pleaque
b.Fibrinoid necrosis
c.Focal granulomatous inflammation
d.Fungal hyphae

Solution:

The suspected disease in this case is temporal arteritis,also denoted by the term Giant cell arteritis because of the
focal granulomatous inflammaion (with gaint cells)that characterized the process.

The most usally involved arteries are the cranial arteies (branches of the carotid system)

Vigorous attempts at diagnosis which may need biopsying 2-cm lengths of each temporal artery are indicated since the process
can be patchy.
Correct diagnosis is necessary because untreated temporal arteritis can involve the opthalmic artery leading to irreversible
blindness
Atherosclerosis is alsmost never observed in the distal (lower blood pressure )Part of the temporal artery
Fibrinoid necrosis is a vharacteristic of polyarteritis nodosa and not that of temporl arteritis
Fungal hyphae would point at a fungal infection instead of temporal arteritis.

Ref:
Surrmond .2009,Section 14 . The Skin in Immune, Autoimmune,and Rheumatic disorders. In D.Suumond Ed.Fitzpatrick’s color
atlas & synopsis of clinical dermatology,6e.