Eric J. Lewis, MD

This contorted hand of a 49-year-old man demonstrates Dupuytren's contracture, a disorder first described by Baron Guillaume Dupuytren in 1831. Although the condition may occur as a completely independent abnormality, it is commonly associated with chronic liver disease, diabetes mellitus, epilepsy, palmar fasciitis, carpal tunnel syndrome, rheumatoid arthritis, pulmonary tuberculosis, and alcoholism. This patient had a history of alcohol abuse.

Loss of pigmentation is noted around the left eye of a 49-year-old African-American man-the same eye in which he has a detached retina. In addition, the patient's hearing is impaired on that side.

Severely limited vision plagues this 27-year-old woman with aniridia, the bilateral absence of the iris of the eye.

The lesions seen here developed shortly after a 54-year-old woman started psoralen plus UVA (PUVA) therapy for psoriasis. This is acne estivalis, an uncommon actinic, acneiform eruption. The firm, red, monomorphic papules are most commonly found on the shoulders, arms, neck, and chest. Histologically, they resemble steroid acne. Lesions develop in the spring, peak in the summer, and resolve in the fall without scarring.

Seen here are a 38-year-old Native American woman and her 20-year-old daughter, each of whom has had a relapsing eruption for several years. Pruritic, red to red-brown plaques develop on their faces and necks and on the dorsal surface of their hands. Scattered brown and hypopigmented macules as well as some scaling and slight erythema appear on their lower lips. The women stated that the eruptions flare each spring and gradually improve throughout the rest of the year. The daughter's lesions were more acute at this time and had developed during the preceding 3 days.

A 57-year-old man with a history of venous stasis leg ulcerationwondered about the “white spots” on his leg. Thecondition is atrophie blanche, which manifests as smooth,ivory-white macules and plaques of sclerosis stippled withtelangiectasia that often are surrounded by mild to moderatepigmentation.

Cutaneous manifestations develop inapproximately 30% of persons withdiabetes. Premature atherosclerosisis a common complication of thedisease and can cause peripheral infarction,ulceration, and necrosis.