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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Dermatology, Neurology
|SubCategory=Dermatology, Neurology
|Prompt=A 74 year old male patient with a significant history of a chronic neurological disease presents to the physician's office complaining of a new scalp lesion.  The patient reports his only medication is ropirinole that has been well-tolerated.  He has no history of allergies.  He does not smoke and does not drink alcohol.  On physical examination, the physician notes on inspection the lesion shown in the image below.  Further physical examination shows a tremor at rest, jerky muscular movements upon active bending of the limb, and bradykinesia.  Following appropriate work-up, the physician informs the patient that his scalp lesion is in fact associated with his neurological condition.  What is the most likely diagnosis of the patient's scalp lesion?
|Prompt=A 74-year-old male, with a significant history of a chronic neurological disease, presents to the physician's office with complaints of a new scalp lesion.  The patient reports that his only medication is ropirinole, which has been well-tolerated.  Upon physical examination, you note the lesion (displayed in the image below), a tremor at rest, jerky muscular movements upon active bending of the limb, and bradykinesia.  Following appropriate work-up, you inform the patient that the scalp lesion is associated with his neurological condition.  Which of the following diagnoses most likely corresponds with the patient's scalp lesion?


[[Image:WBR Seborrheic dermatitis.jpg|250px]]
[[Image:WBR Seborrheic dermatitis.jpg|250px]]
|Explanation=Seborrheic dermatitis is an inflammatory skin disease with sebum secretions due to malassezia furfur that occurs most often on the face, scalp, and chest.  On histology, seborrheic dermatitis is best characterized by parakeratosis (retained nuclei in stratum corneum), orthokeratosis (formation of anuclear keratin layer), and follicular plugs.  Also, there is cyclical "squirting" of granulocytes from the dermal papilla.  Seborrheic dermatitis is best treated using any of several topical antifungal medications, and keratinolytic agents, such as selenium sulphide.


The patient presents with findings on physical examination that suggest Parkinson's disease; that are further emphasized by the use of ropirinole, a non-ergotamine dopamine agonist. Patients with Parkinson's disease often have resting or "pill-rolling" tremor, cogwheel rigidity upon active flexion of the limbs, and bradykinesia.
|Explanation=[[Seborrheic dermatitis]], an inflammatory skin disease with sebum secretions due to malassezia furfur, frequently manifests on the face, scalp, and chest.  On histology, [[seborrheic dermatitis]] is best characterized by parakeratosis (retained nuclei in stratum corneum), orthokeratosis (formation of anuclear keratin layer), and follicular plugs. Often, there is cyclical "squirting" of granulocytes from the dermal papilla.  [[Seborrheic dermatitis]] is optimally treated with topical antifungal medications and keratinolytic agents, such as selenium sulphide.


The association between Parkinson's disease and seborrheic dermatitis is well established with a poorly understood pathophysiology. The level of seborrhea, however, does not seem to correlate with the degree of Parkinson's disease.  Other factors associated with seborrheic dermatitis are HIV/AIDS, mood disorders, and winter weather.
Findings upon the patient's physical examination suggest [[Parkinson's disease]] and are further emphasized by his use of [[ropirinole]], a non-ergotamine dopamine agonist. Patients with [[Parkinson's disease]] often present with a resting or "pill-rolling" tremor, cogwheel rigidity upon active flexion of the limbs, and bradykinesia.


Educational Objective: Seborrheic dermatitis is an inflammatory skin condition that commonly affects the face, scalp, and chest.  It is caused by Malassezia furfur and is commonly associated with Parkinson's disease.
There is an established association between [[Parkinson's disease]] and [[seborrheic dermatitis]]. The level of seborrhea, does not appear to correlate with the degree of [[Parkinson's disease]]. Other factors associated with [[seborrheic dermatitis]] are [[HIV]]/AIDS, mood disorders, and winter weather.
 
|EducationalObjectives= [[Seborrheic dermatitis]], an inflammatory skin condition, frequently manifests on the face, scalp, and chest.  [[Seborrheic dermatitis]] is caused by Malassezia furfur and is often associated with [[Parkinson's disease]].
 
|References= Gupta AK, Bluhm R. Seborrheic dermatitis.  Journal of the European Academy of Dermatology and Venereology. 2003;18(1): 13-26


Reference:
Gupta AK, Bluhm R. Seborrheic dermatitis.  Journal of the European Academy of Dermatology and Venereology.  2003;18(1): 13-26
|AnswerA=Candida albicans
|AnswerA=Candida albicans
|AnswerAExp=Candida albicans is not commonly associated with Parkinson's disease.  Howevever, candida albicans, similar to seborrheic dermatitis, is also a fungal inflammation of the skin that causes erythema and should be considered in the differential diagnosis of seborrheic dermatitis.
|AnswerAExp=[[Candida albicans]] is not frequently associated with [[Parkinson's disease]].  Candida albicans is a fungal inflammation of the skin, which leads to erythema and should be considered in the differential diagnosis of seborrheic dermatitis.
|AnswerB=Eczema
|AnswerB=Eczema
|AnswerBExp=Eczema is a type of dermatitis that is often a scaling lesion located at skin flexures.  It is commonly found in children with atopy, such as asthma.  It is not commonly associated with Parkinson's disease.
|AnswerBExp=[[Eczema]], a type of dermatitis that is often a scaling lesion located at skin flexures, frequently manifests on children with atopy, such as asthma.  It is not usually associated with [[Parkinson's disease]].
|AnswerC=Psoriasis
|AnswerC=Psoriasis
|AnswerCExp=Psoriasis is a silvery scaling papule or plaque that should always be considered in the differential diagnosis of seborrheic dermatitis.  It is characterized by increase in the stratum spinosum layer of the skin and a decrease of the stratum granulosum.  Psoriasis commonly presents in younger individuals.  A positive Auspitz sign, defined as bleeding when scaled are scraped off, is characteristic on physical exam.  Psoriasis is not commonly associated with Parkinson's disease.
|AnswerCExp=[[Psoriasis]] is a silvery scaling papule or plaque that should be considered in the differential diagnosis of seborrheic dermatitis.  [[Psoriasis]] is characterized by increase in the stratum spinosum layer of the skin and a decrease of the stratum granulosum.  [[Psoriasis]] commonly manifests in younger individuals.  A positive Auspitz sign, bleeding when scales are scraped off, is characteristic upon physical exam.  [[Psoriasis]] is not commonly associated with [[Parkinson's disease]].
|AnswerD=Urticaria
|AnswerD=Urticaria
|AnswerDExp=Urticaria or hives is a skin manifestation of allergic conditions that is characterized by raised erythematous itchy wheals with central clearing.
|AnswerDExp=Urticaria, or hives, is a skin manifestation of allergic conditions, which is characterized by raised erythematous itchy wheals with central clearing.
|AnswerE=Seborrheic dermatitis
|AnswerE=Seborrheic dermatitis
|AnswerEExp=Seborrheic dermatitis is an inflammatory skin disease caused by Malassezia furfur.  It is associated with Parkinson's disease.
|AnswerEExp=See overall explanation.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=seborrheic, dermatitis, seborrheic dermatitis, parkinson's, parkinson, cogwheel, rigidity, bradykinesia, resting, pill, rolling, tremor
|WBRKeyword=seborrheic dermatitis, parkinson's disease, tremor, dermatology, lesion, fungal, neurology, skin
|Approved=No
|Approved=Yes
}}
}}

Revision as of 17:40, 30 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Dermatology, SubCategory::Neurology
Prompt [[Prompt::A 74-year-old male, with a significant history of a chronic neurological disease, presents to the physician's office with complaints of a new scalp lesion. The patient reports that his only medication is ropirinole, which has been well-tolerated. Upon physical examination, you note the lesion (displayed in the image below), a tremor at rest, jerky muscular movements upon active bending of the limb, and bradykinesia. Following appropriate work-up, you inform the patient that the scalp lesion is associated with his neurological condition. Which of the following diagnoses most likely corresponds with the patient's scalp lesion?

]]

Answer A AnswerA::Candida albicans
Answer A Explanation [[AnswerAExp::Candida albicans is not frequently associated with Parkinson's disease. Candida albicans is a fungal inflammation of the skin, which leads to erythema and should be considered in the differential diagnosis of seborrheic dermatitis.]]
Answer B AnswerB::Eczema
Answer B Explanation [[AnswerBExp::Eczema, a type of dermatitis that is often a scaling lesion located at skin flexures, frequently manifests on children with atopy, such as asthma. It is not usually associated with Parkinson's disease.]]
Answer C AnswerC::Psoriasis
Answer C Explanation [[AnswerCExp::Psoriasis is a silvery scaling papule or plaque that should be considered in the differential diagnosis of seborrheic dermatitis. Psoriasis is characterized by increase in the stratum spinosum layer of the skin and a decrease of the stratum granulosum. Psoriasis commonly manifests in younger individuals. A positive Auspitz sign, bleeding when scales are scraped off, is characteristic upon physical exam. Psoriasis is not commonly associated with Parkinson's disease.]]
Answer D AnswerD::Urticaria
Answer D Explanation AnswerDExp::Urticaria, or hives, is a skin manifestation of allergic conditions, which is characterized by raised erythematous itchy wheals with central clearing.
Answer E AnswerE::Seborrheic dermatitis
Answer E Explanation AnswerEExp::See overall explanation.
Right Answer RightAnswer::E
Explanation [[Explanation::Seborrheic dermatitis, an inflammatory skin disease with sebum secretions due to malassezia furfur, frequently manifests on the face, scalp, and chest. On histology, seborrheic dermatitis is best characterized by parakeratosis (retained nuclei in stratum corneum), orthokeratosis (formation of anuclear keratin layer), and follicular plugs. Often, there is cyclical "squirting" of granulocytes from the dermal papilla. Seborrheic dermatitis is optimally treated with topical antifungal medications and keratinolytic agents, such as selenium sulphide.

Findings upon the patient's physical examination suggest Parkinson's disease and are further emphasized by his use of ropirinole, a non-ergotamine dopamine agonist. Patients with Parkinson's disease often present with a resting or "pill-rolling" tremor, cogwheel rigidity upon active flexion of the limbs, and bradykinesia.

There is an established association between Parkinson's disease and seborrheic dermatitis. The level of seborrhea, does not appear to correlate with the degree of Parkinson's disease. Other factors associated with seborrheic dermatitis are HIV/AIDS, mood disorders, and winter weather.
Educational Objective: Seborrheic dermatitis, an inflammatory skin condition, frequently manifests on the face, scalp, and chest. Seborrheic dermatitis is caused by Malassezia furfur and is often associated with Parkinson's disease.
References: Gupta AK, Bluhm R. Seborrheic dermatitis. Journal of the European Academy of Dermatology and Venereology. 2003;18(1): 13-26]]

Approved Approved::Yes
Keyword WBRKeyword::seborrheic dermatitis, WBRKeyword::parkinson's disease, WBRKeyword::tremor, WBRKeyword::dermatology, WBRKeyword::lesion, WBRKeyword::fungal, WBRKeyword::neurology, WBRKeyword::skin
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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