A healthy,1-mo-old, full-term Moroccan infant with an hx of erythema toxicum neonatorum in the first wk of life was seen for an itchy rash on her hands and feet. Exam showed vesiculopustular lesions and excoriations, but no burrows. What is it?
Coxsackie virus
Scabies
Bullous pemphigoid
Eczema
Infantile acropustulosis
You are correct. Infantile acropustulosis is a recurrent, self-limited, pruritic, vesiculopustular eruption on the distal extremities occurring during the first 2 to 3 yrs of life. Lesions may last up to 14 days, resolve and relapse in a few weeks. Intensity and duration of attacks diminish with each recurrence. It is frequently misdiagnosed as scabies, erythema toxicum neonatorum, or transient neonatal pustular melanosis. Treatment is supportive.
A 30-yo woman c/o brownish nail discoloration. Three weeks earlier she was admitted to the Neuro ICU with LOC and seizures, diagnosed w/ superior sagittal sinus thrombosis and cerebral venous infarctions. She was then anticoagulated. What is the nail finding?
Onychogryphosis
Coma nails (subungual hematoma)
Beau's lines
Terry's nails
Splinter hemorrhages
You are correct. This patient developed coma nails or bilateral subungual hematomas caused by frequent nail bed compression with a pencil to monitor motor response as a form of noxious stimuli while in a comatose state in the neurological ICU.
A 37-yo woman with no PMHx c/o hair loss. The first episode occurred 4 mo after the death of her father. The hair loss slowed, but after a miscarriage, it flared again. Iron stores were low. Iron supplementation improved hair volume, but hair shedding recurred after starting OCPs. What is the diagnosis?
Telogen effluvium
Secondary syphilis
Trichotillomania
Normal hair shedding
Tinea capitis
You are correct. Telogen effluvium is a self-limiting, non-scarring, diffuse alopecia that can occur in either sex at any age. The loss of >100 hairs per day is considered abnormal. Shed telogen hair shafts are recognized by their depigmented proximal tips, club-shaped roots, and absence of root sheath. Hormonal changes, stress, and iron deficiency are all known triggers. A triggering event usually occurs 1 to 6 mos prior to the onset of hair loss. The patient's hair regrew to normal density.