A 22-year-old-woman comes to the office with a rash that started 2 days earlier with the sudden appearance of multiple red spots on the trunk and arms. The rash is mildly pruritic but not painful. She has used no new medications or over-the-counter hygiene products. The patient had a sore throat that started 2 weeks ago and is slowly getting better. She has no other medical problems and takes no prescription medications. She drinks 2 or 3 beers on the weekend but does not use tobacco or illicit drugs.
On physical examination, the patient appears well. Vital signs are normal. The throat has erythema but no exudate. No cervical lymphadenopathy is noted. Cardiopulmonary examination is normal. The rash is shown in the photograph below. The palms and soles are spared.

Which of the following is the most likely diagnosis?

Question

A 22-year-old-woman comes to the office with a rash that started 2 days earlier with the sudden appearance of multiple red spots on the trunk and arms.  The rash is mildly pruritic but not painful.  She has used no new medications or over-the-counter hygiene products.  The patient had a sore throat that started 2 weeks ago and is slowly getting better.  She has no other medical problems and takes no prescription medications.  She drinks 2 or 3 beers on the weekend but does not use tobacco or illicit drugs.
On physical examination, the patient appears well.  Vital signs are normal.  The throat has erythema but no exudate.  No cervical lymphadenopathy is noted.  Cardiopulmonary examination is normal.  The rash is shown in the photograph below.  The palms and soles are spared.

Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec193a_9781_3f22_853d_99714ec04025_MD0002_00 This patient has guttate psoriasis (from Latin gutta: [rain]drop), a variant of psoriasis characterized by numerous small erythematous papules and plaques with a fine scale. The lesions are usually found on the trunk and proximal extremities but typically spare the palms and soles. Guttate psoriasis occurs most commonly in children and young adults, and the risk is increased in individuals with a history of plaque psoriasis. Guttate psoriasis has an acute onset, typically 2-3 weeks after streptococcal infection (eg, pharyngitis, cellulitis). The diagnosis can usually be made based on clinical findings, although skin biopsy is useful if the diagnosis is in doubt. The course of guttate psoriasis is variable, and the condition often resolves spontaneously within a few months; in a minority of cases, it may progress to chronic plaque psoriasis. If treatment is needed, phototherapy is usually preferred over topical glucocorticoids and vitamin D analogs (eg, calcitriol) due to the widespread nature of the disease. Despite the link to streptococcal infection, the benefits of systemic antibiotics and tonsillectomy are controversial in patients without evidence of active infection (eg, fever, sore throat, tonsillar exudate). (Choice A) Discoid lupus erythematosus presents with erythematous, scaly plaques that develop atrophy and pigmentary changes over time. The lesions preferentially involve sun-exposed areas, and the onset is chronic rather than acute. scaly plaques (Choice B) Erythema nodosum presents with painful subcutaneous nodules, primarily on the lower extremities. The overlying skin is usually erythematous but not scaly. (Choice D) Nummular eczema may present with single or multiple round papules and plaques that are highly pruritic. The extremities are more often affected, and serous drainage may be present. Nummular eczema (Choice E) The papulosquamous eruption of secondary syphilis often starts on the trunk but usually involves the palms and soles; it is typically associated with generalized adenopathy and constitutional symptoms. secondary syphilis Educational objective: Guttate psoriasis is a variant of psoriasis characterized by numerous small erythematous papules and plaques with a fine scale. It typically occurs 2-3 weeks after streptococcal infection (eg, pharyngitis, cellulitis) and is commonly seen in children and young adults. Diagnosis is made primarily by clinical examination. __________ References: Psoriasis, guttate. (http://www.ncbi.nlm.nih.gov/pubmed/29494104) To treat or not to treat? Management of guttate psoriasis and pityriasis rosea in patients with evidence of group A streptococcal infection. (http://www.ncbi.nlm.nih.gov/pubmed/20232586)

A 22-Year-Old-Woman Comes to the Office with a Rash That