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Darier disease — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSkin biology & researchDarier diseaseSCE Dermatology

A dialysis patient develops rapidly progressive, exquisitely painful retiform plaques on adipose thighs with firm subcutaneous calcification. There is no fluctuance and pain precedes necrosis. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Assess as calciphylaxis before choosing whether and where to biopsy

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

E is correct. Severe pain out of proportion, retiform induration and evolving necrosis in advanced kidney disease are classic warning features of calciphylaxis. This requires urgent renal, dermatology, pain, wound and surgical input; infection, vascular occlusion and vasculitis are assessed concurrently. Serum calcium may be normal and does not exclude the diagnosis. Biopsy can demonstrate arteriolar calcification and thrombosis but may enlarge a nonhealing ulcer, so site and necessity are individualized. Early management addresses pain, wound infection, dialysis and mineral-bone factors rather than delaying behind a routine cellulitis course.

Reference: UK Kidney Association: calciphylaxis information and guidance: https://www.ukkidney.org/rare-renal/clinician-information/calciphylaxis