Quiz 16

A 25yo man comes to you in the outpatient setting and is complaining of a rash that has started off in his face and scalp. It is seen worst in the nasolabial folds. It is scaly and looks like dandruff. Which of the following tests is appropriate to elicit an etiology.

1. chest x ray
2. HIV serology
3. skin biopsy
4. ANA (anti nuclear antibodies)
5. viral culture

Answer is choice 2. (HIV serology) A similar question was on the board exam. It is important to know that sudden extensive seborrhea, especially if it is resistant to routine treatment, is a sign of HIV. Neither a chest X-ray, nor any of the other choices is likely to reveal the etiology of the seborrhea.

Q2. A 35y o lady comes to you for her concern of hair loss. You see that there is a lot of hair loss in a patchy distribution and you take a skin biopsy that shows follicular plugging and hyperkeratosis.
Which of the following diagnoses is likely.

1. SLE (systemic lupus erythematosus)
2. DLE (discoid lupus erythematosus)
3. alopecia areata
4. constitutional hair loss
5. androgen excess

Answer is choice 2. DLE (discoid lupus erythematosus). Whenever one sees follicular plugging/destruction, there are just a few etiologic causes (DLE, l8ichen planus, morphea and cutaneous lupus (not SLE that is systemic). These are the causes that cause scarring alopecia. The commonest type of alopecia that SLE causes is non scarring type that can actually grow back. Androgenic alopecia , alopecia areata and constitutional loss too are non scarring.