2025 – PAGE 147 – DERMATOLOGY

PAPULAR URTICARIA

Papular urticaria is a rash due to hypersensitivities to the insect bites of bedbugs, fleas, and mosquitoes that results in edema, erythema, and pruritis. It presents in RECURRENT CROPS. It tends to come and go, wax and wane every few weeks or months. Some lesions may be umbilicated. Treat by removing the offending agent (fleas, lice, bedbugs, or outside insects).

PEARL: You may not be given the history of a specific insect or exposure.

MNEMONIC. “CROPular Urticaria.” Where do you find insects? In CROPS, of course!

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VITILIGO

Vitiligo results in depigmented macules. Look for a “salt and pepper” type of pattern of re-pigmentation. It is often associated with HALO NEVI.

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(NAME ALERT) ICHTHYOSIS VULGARIS

Ichthyosis vulgaris is a rash that resembles FISH SCALES. It is often seen in atopic dermatitis patients. You may attempt treatment with ammonium lactate or alpha-hydroxy-acid containing agents. The name alert is for lamellar ichthyosis and harlequin ichthyosis.

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(NAME ALERT) LAMELLAR ICHTHYOSIS (AKA COLLODION BABY)

Lamellar ichthyosis (AKA collodion baby) is noted at the time of birth in newborns. A thin, transparent film is noted on the body. Eyelashes are missing. Eyelids seem everted (ectropion). The name alert is for harlequin ichthyosis and ichthyosis vulgaris.

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(NAME ALERT) HARLEQUIN ICHTHYOSIS

Harlequin ichthyosis presents with a newborn that looks much more abnormal than lamellar ichthyosis. The covering is hard (“armor-like”) and horny. Movement is restricted. Prognosis is poor comparatively. The name alert is for lamellar ichthyosis and ichthyosis vulgaris.

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PYODERMA GANGRENOSUM

The etiology of pyoderma gangrenosum is unknown, but it is known to be associated with other systemic diseases such as Crohn’s. Lesions are described as deep, bluish, necrotic, and boggy-looking ulcers.

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