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Patient's Itchy Rash Identified by Comparing to VisualDx's Medical Images

sezarysyndrome_77094.jpgJohn D., a dermatology resident at the University of South Florida, shares how VisualDx helped him understand his patient's pruritic rash and teach the medical student rounding with him.

"Our team was consulted for a very pruritic erythrodermic patient. Patient's rash began roughly 1-2 weeks prior and became confluent. The patient was a poor historian and no previous records were available. While biopsy was essential, given the severity of the rash, developing an initial differential diagnosis for workup was also crucial. I was able to use VisualDx to compare photographs, diagnostic pearls and treatment options quickly and efficiently. These high quality photographs were also used to educate the medical student who was participating in rounding on our consulted patients. VisualDx provided a tool to not only diagnose but teach. The patient was eventually diagnosed with Sézary syndrome in an expedited manner because of the efficiency of clinical and diagnostic tools VisualDx provided."

Sézary syndrome pictured here is not the patient in this case study. See more pictures of Sézary syndrome in VisualDx.

So, what exactly is Sézary syndrome?

Sézary syndrome accounts for less than 5% of all primary cutaneous T-cell lymphoma cases. Erythroderma, generalized lymphadenopathy, and neoplastic T-cells (Sézary cells) in the skin and lymph nodes are classic characteristics of Sézary syndrome.

What should we be aware of when making a diagnosis?

Look for: 

  • Small, annular, minimally elevated papules (2-5 mm), which can number in the hundreds
  • Erythroderma
  • Generalized lymphadenopathy
  • Extreme pruritus
  • Palmoplantar hyperkeratosis
  • Lichenification
  • Edema
  • Exfoliation
  • "Deck chair" or "folded luggage" sign - alternating bands of pigment and erythema with uninvolved skin around flexural areas
  • Nail defects

How can we treat this?

Systemic treatment is required. There are a number of therapies including interferon and methotrexate. VisualDx has more detailed information about specific Sézary syndrome therapies. Launch VisualDx now to learn more or start your free 30-day trial of VisualDx today.

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About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at www.visualdx.com.

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