1. Sally McFarland is a new patient seen in your clinic today to establish care. She has several comorbidities including acne rosacea, depression, hyperlipidemia, and hypothyroidism. One of her main concerns is these bruise-like spots that have been on her shins for several months. She is worried as she does not recall any injuries in these areas, and she states her aunt had easy bruising before she was diagnosed with Leukemia. On assessment you visualize 3 gray to blue patches on her left shin and 2 on her right shin ranging in size from 1 cm to 2.5 cm. All the areas appear the same coloring. After looking at her medication list, which of the following medications would be the most common to present with these type findings?
Simvastatin 10 mg daily
Baby aspirin 81mg daily
Minocycline 100mg daily
Drospirenone/ethinyl estradiol 3mg/20mcg daily
Answer and rationale: C. Minocycline
Patients often mislabel findings on their skin as something more common. Sally thought she was bruising easily, but with the objective listed of gray-blue and all of the areas appearing the same it is more consistent with hyperpigmentation. There are still quite a few rosacea patients that are on chronic MCN. There are several types of hyperpigmentation that can occur with chronic exposure to this medication. Type II hyperpigmentation with MCN is blue-gray macules/patches within previously normal skin. Shins are a very common location for hyperpigmentation with MCN and are often misdiagnosed as ecchymoses. 2. The following are consistent with diagnosis of Candida intertrigo EXCEPT:
KOH+ pseudohyphae and spores
Satellite papules and pustules
Erythema occurring on moist skin fold areas
Woods lamp exhibits coral red fluorescence
Answer and rationale: D. Woods lamp exhibits coral red fluorescence.
The clues under the microscope listed with the KOH as well as the physical findings of satellite papules and erythema in fold areas, would all be used as part of diagnosing a patient with Candida caused intertrigo. The woods lamp that exhibits a coral red fluorescence would be diagnostic to corynebacteria minutissimum found in patient’s with erythrasma.