By vgreene, 14 January, 2016
By vgreene, 14 January, 2016
By vgreene, 14 January, 2016
(BMJ)—A 23-yo man presented w/ a rash that began on his palms and soles. It first appeared 8 wks after he immigrated to the U.S. and 2 wks after a sore throat and fever that resolved. Doxycycline (for presumptive Rocky Mountain spotted fever) resulted in no improvement. Exam: Diffuse pink papules w/ silvery scale. What is the dx?
Drug reaction
Guttate psoriasis
Coxsackie virus
Syphilis
Mycosis fungoides
You are correct. Guttate psoriasis is a benign inflammatory dermatosis characterized by numerous eruptive papules and plaques on the trunk and extremities. A preceding streptococcal infxn is seen in more than half of pts who develop acute guttate psoriasis. This pt had raised anti-streptolysin-O and anti-DNase-B titers, confirming recent strep infxn. Antibodies to coxsackievirus and Rocky Mountain spotted fever were negative. He was treated successfully w/ triamcinolone and topical calcipotriol and had no relapse after 1 yr.
By vgreene, 7 January, 2016