Photos, facts and fibs... Rash decisions
When is it an allergy?
Vol.18, No.04, April 2010

This quiz is just for fun. Test your diagnostic skills with the photos, then separate truth from fiction in the statements about pseudoanaphylaxis and lichen planus. Any of the statements below might be true… and any might just be us pulling your leg. Answers are below.

1. Match the pictures below to the following conditions:

a) Poison ivy rash

b) Allergic contact dermatitis

c) Erysipelas

d) Lyme disease

e) Nummular eczema

f) Ringworm

g) Scabies

h) Shingles

i) Parvovirus (Fifth disease)

j) Rosacea

k) Lupus malar (butterfly) rash

l) Heat rash (Miliaria)

2. Pseudoanaphylaxis

True False

a) ... is not a true allergic reaction

b) ... is associated with lower morbidity and mortality than true anaphylaxis

c) ... can be caused by morphine and muscle relaxants

d) ... can be caused by aspirin

e) ... can be caused by radiocontrast medium

3. Lichen planus

True False

a) ... often develops at trauma sites

b) ... commonly affects the trunk and shoulders

c) ... may leave hyperpigmented skin

d) ... is often treated with isotretinoin

e) ... can’t affect the nails

ANSWER

1. Match the pictures with the conditions: 1.j) Rosacea; 2.e) Nummular eczema; 3.l) Heat rash (Miliaria); 4.a) Poison ivy rash; 5.h) Shingles; 6.i) Parvovirus (Fifth disease); 7.k) Lupus malar (butterfly) rash; 8.b) Allergic contact dermatitis; 9.d) Lyme disease; 10.g) Scabies; 11.f) Ringworm; 12.c) Erysipelas.

2. Pseudoanaphylaxis: a) True, it is not IgE-mediated, but is due to direct mast cell degranulation; b) False, morbidity and mortality are similar; c) True; d) True; e) True.

3. Lichen planus: a) True, this is Koebner’s phenomenon; b) False, commonly affects the palms, soles, wrists, ankles, scalp and mouth; c) True; d) False, strong local steroids are the standard treatment; e) False, affected nails may suffer permanent damage.

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We'll send you $100 if we print your diagnostic challenge. Send case description (app. 450 words) with final diagnosis and outcome to: parkex@parkpub.com.

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