Dermatology

Patients with mycotic toenails whoare unable to take oral antifungalagents may find relief with this oldremedy.

My patient-an 84-year-old woman with hypertension-presented with itchingand blistering of 3 days’ duration on her right foot (Figure).

What Are Trigger Points?Tender areas, swellings, or knots under the skin are referred to as“trigger points.” Injection of these trigger points with medication mayalleviate discomfort. At times you may feel pain in an area distant fromthe trigger point. Your doctor will feel the various muscle groups tolocate the trigger points and the most tender areas.

An area of pigment loss in the skinand surrounding hair is noted on thehead of a 10-year-old boy. Examinationof the vertex of the scalp revealsa nevus encircled by depigmentation.

A 35-year-old woman has a lifelong history of recurrent blisters on the handsand feet that heal without scarring. No other family members have this condition,and she has no children. She is visiting your office for the first time toseek new treatment options.

A recent Dermclinic case featured a teenaged girl with seborrheic dermatitis thatmanifested as a scaly, slightly itchy rash on her upper eyelids (CONSULTANT,April 15, 2002, page 611).

A 12-month-old previously healthy boypresented to the pediatric emergencydepartment (ED) with a 10-day historyof fever, irritability, and anorexia.The patient’s mother had originallynoted the development of 3 erythematouspapules on the patient’s back, leftaxilla, and chest; these were followedby the onset of daily fevers, with temperaturesranging from 38.8°C to41.1°C (102°F to 106°F). The lesionsgrew progressively larger and erythematous,and became ulceratedwith central eschars.

For several weeks, a 68-year-old man has had painful blisterson his hands that crusted as they healed. The patienthas diabetes mellitus, hypertension, and chronic renalfailure, for which he is undergoing hemodialysis. His longtermmedications include a hypoglycemic agent and adiuretic.

Case 1: A 42-year-old woman presents for anevaluation of an acute pruritic eruptionthat began 2 days earlier on herface, trunk, and extremities. The lesionsresolve and recur at differentsites from one day to the next. Theoutbreak began after the patient ateChinese food the night before; shealso had a recent sinus infection. Shetakes vitamins and hormone replacementtherapy.

A 9-year-old boy, who has no significantmedical history, presents with a generalizedpruritic eruption of 2 weeks’ duration.One week earlier, another practitionerruled out scabies and treatedhim presumptively for varicella.

Until they can see a physician,patients can try using cold milk compresses(whole milk, low-fat, or skim)for temporary relief from the itchingof poison ivy or simple eczema.

When sterile saline is needed for repeatedhome use (eg, for daily cleansingof a foot ulcer), suggest thatthe patient buy an over-the-counter,

Are there health or safety concerns associated with “instant”tanning products?

A 16-year-old Somali girl presents witha 3-day history of bilateral arm swellingand painful vesicular eruptions; hersymptoms are worsening. She reportsthat 5 days earlier, she and her friendshad used henna and black hair dyeto “tattoo” their skin. The others havenot experienced similar signs or symptoms.This patient has used henna(which is dark red) since childhoodfor decorative purposes. However, outliningan intricate design with hairdye is new for her.

A4-year-old boy has a 4-day historyof fever; a persistent dry,irritating cough; coryza; and anonpruritic rash. The rash startedaround the ears and then spread overthe trunk and limbs.

Dr David Kaplan presented the case of a teenager with aphthous stomatitis in aDermclinic feature.

A healthy 21-year-old man presented with a rapidly growing, filiform, ringshapedwart on his great toe (Figure).

My patient is a 70-year-old man who has had several episodesof cellulitis in his right thigh; he does not have diabetes.After the third episode, a 1-cm subcutaneous mass was excisedabove the area of recurrent cellulitis.

During a routine physical examinationof a 21-year-old man, a 1-cm cysticlesion is detected on the posterior wallof the lower nasopharynx.

What are the latest recommendations concerning the treatmentof dermatomyositis?

For 15 years, a 33-year-old man hashad scale on the soles of his feet;the condition has failed to respondto various topical antifungal agents.He has no other rashes. He ishealthy except for a history of seasonalallergies controlled by overthe-counter medications.

I noticed that “Sebaceous Cyst” was used as the title of arecent Photoclinic case, contributed by Drs Leslie, Hillel,and Shlomo Trope (CONSULTANT, June 2004, page 1025)(Figure).

Instead of nail removal, another option for treating a subungualabscess is to scrub the digit and drill a hole in thenail plate with a hot wire loop.

A 101-year-old woman has had an occasionallypruritic and tender growthon her face for about 2 months. Thegrowth has doubled in size over the past2 weeks. She has no personal or familyhistory of cancer or significant dermatologicdisorders.

A painful scalp eruption of 4 days’duration brings an 81-year-old man toyour office. He has taken a lipid-loweringagent and an antihypertensivefor years but has not started any newmedications recently. One week earlier,he had a haircut. He denies recenttrauma to the scalp.

Contact dermatitis on the dorsumof the foot is often treated as aleather or rubber allergy that isexacerbated by the patient’s shoes.

My patient has a test-proven Candida allergy. Because hepatitis B virus (HBV)vaccine contains yeast, another physician would not give it to him. I administereda diluted dose and then a full-strength dose of the HBV vaccine, and the patienthad no adverse reaction.

I am seeing an increasing number of patients with tattoos, including radiationtattoos.

When you treat a patient for tineacruris (jock itch), always check hisfeet as well.

A 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.