WBR0535
| 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?
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| 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. |
| 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:: |
