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Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.
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29 respondents
Question of 1
Scabies
Wrong answer!
It was atopic dermatitis.
Let’s rule out differential diagnoses:
Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic.
Animal contact and mycology if necessary.
Atopic dermatitis
Atopic dermatitis
It is indeed atopic dermatitis.
Let’s rule out differential diagnoses:
Nocturnal pruritus, pruritus in family members, infectious
contact, clinical features with furrows.
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic.
Animal contact and mycology if necessary.
Psoriasis
Wrong answer!
It was atopic dermatitis.
Let’s rule out differential diagnoses:
Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic.
Animal contact and mycology if necessary.
Mycosis
Wrong answer!
It was atopic dermatitis.
Let’s rule out differential diagnoses:
Nocturnal pruritus, pruritus in family members, infectious contact, clinical features with furrows.
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Lesions with geographic edges, inflammatory at the edges, with scarring at the centre, centrifugal, recent +- pruritic.
Animal contact and mycology if necessary.
Topical corticosteroids can be prescribed as first line therapy. What is dangerous is steroid phobia!
In short: low-potency class such as desonide (Tridesonit®)
Once a day with no maximum amount, should be started early and continued until clearing.
- Either once or twice a week if flare-ups are frequent
- Or discontinue topical corticosteroids and resume from the first signs of relapse if flare-ups are less frequent.
Use of emollients: at least once a day – that is the basic principle behind maintenance treatment for AD! Moisturises, reduces micro-inflammation and pruritus, regulates the microbiome, eliminates the need for cortisone.
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