VisualDx Diagnosis Challenge!

AN OCEAN SWIMMER went to urgent care after coming into contact with something on the ocean floor during a scuba diving expedition. The patient developed an urticarial plaque on his face. His doctor was concerned about the palpebral conjunctival injection he noted during the exam. Can you diagnose the patient? Use the Differential Builder in VisualDx to help you. HINT: Start with the “Adult Skin – Marine Exposures” clinical scenario, then add other key findings. Look for the answer on our Facebook page on Tuesday, June 30. WHILE MANY PATIENTS accept hair loss as a normal sign of aging, for others it can be extremely distressing. Androgenetic alopecia, also known as male or female patterned hair loss, is the most common type of hair loss, affecting most men and a significant proportion of women to some degree by the time they reach the age of 60.(1) The frequency and severity increase with age. Androgenetic alopecia is nonscarring, meaning that there is a population of cells that can grow and enlarge the hair. Reversal may require ongoing topical and/or oral medication. Health care providers can help ease patient anxiety around hair loss through education and by dispelling common hair loss misconceptions, such as these: Only men experience hair loss. FALSE. Female pattern alopecia usually presents after menopause as diffuse thinning of the central portion of the scalp with sparing of the frontal hairline. Like men, women may benefit from topical minoxidil (Rogaine) to help grow hair. Normal hair grooming practices, including washing, perming, and coloring, are not harmful because androgenetic alopecia is not a primary hair shaft disorder (ie, not associated with increased fragility). Balding is entirely inherited from the maternal grandfather. FALSE. While male pattern hair loss is mostly X-linked and based on the maternal grandfather, research has also shown that a person with a balding father has a significantly greater chance of experiencing hair loss. Both genetic and environmental factors may play a role, and many etiologies remain unknown. Male and female pattern hair loss cannot be prevented. FALSE. Topical minoxidil (Rogaine) and oral finasteride (Propecia) are the best treatments in preventing and stopping hair loss.(2)  If male patients are willing, encourage them to use both. For women, minoxidil alone is the current standard of treatment (finasteride is not yet FDA approved for use in women, as its potential efficacy is still being studied). Hair loss may significantly impact an individual’s self-image.(3) Fortunately, treatments are available to help both men and women. Treatment should be continued for at least 12 months before making a decision about efficacy, although benefits may be seen sooner. If treatment is discontinued, the extent of loss will rapidly progress to where it would have been without treatment. Hair pieces and other methods of camouflage can be offered as treatment alternatives and adjuncts. Treat all other underlying causes of hair loss such as seborrheic dermatitis. All females with pattern hair loss should have basic blood work to rule out underlying thyroid disease or iron deficiency, both of which can lead to telogen effluvium and may mimic pattern hair loss. In female patients, look for signs or symptoms of hyperandrogenism (female patients with a hyperandrogenic state will usually present with a male pattern hair loss with bilateral temporal/frontal recession). If a hyperandrogenic state is suspected, further evaluation is warranted. To see images of androgenetic alopecia, follow the links to VisualDx: Alopecia, female pattern Alopecia, male pattern References: 1. Blume-Peytavi U, Blumeyer A, Tosti A, et al. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol. 2011;164(1):5-15. 2. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008;59(4):547-566; quiz 567-548. 3. Reid EE, Haley AC, Borovicka JH, et al. Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. J Am Acad Dermatol. 2012;66(3):e97-102. VisualDx was featured online earlier this month on CNN's Vital Signs with Dr. Sanjay Gupta! Learn how VisualDx helps providers make accurate diagnoses of unfamiliar diseases, identify and diagnose travel-related infections, and speed diagnosis by presenting diverse images of disease.   "People present in different ways," says Dr. James Shoemaker, emergency physician at Elkhart General Hospital, Indiana -- who uses the app every day for more rapid diagnoses. "This has pictures of different skin colors," he says. - CNN's Vital Signs With our mobile apps and EHR-integrated software we strive to ensure that our 1,300 conditions and nearly 30,000 images are at your fingertips where and when you need them. Read more of the article in Vital Signs today!   CHANGING THE CLINICAL SCENARIO Customize your differential or search results in VisualDx by changing the clinical scenario. This powerful tool allows you to view different presentations of a diagnosis. For instance, you may want to see an example of Herpes zoster in an immune suppressed patient, child, or only on a particular body location. On the desktop. You can change the clinical scenario on the desktop version of VisualDx in two places. In the top search bar, there is a drop down menu with a list of all the clinical scenarios available for each diagnosis. Alternatively, you can choose from a quick list of commonly used clinical scenarios on the left menu and click to expand a more extensive menu. On the iPad. The clinical scenario is located in the left menu. Simply scroll down the menu and select a different scenario to see a new set of images. On the iPhone. To choose a different clinical scenario, select the clinical setting at the bottom of the diagnosis. A new window will come up showing all of the clinical scenarios that are available for the diagnosis. Choose a new scenario to see a new set of images. On an Android phone. The clinical scenario is located in the top menu bar. Click on the drop down menu and select a different scenario to see a new selection of images for the diagnosis. Copyright © 2015 VisualDx, All rights reserved.