Dermatology

A 73-year-old man is admittedto the hospital with pulmonary tuberculosis.A 3-drug fixed combination-isoniazid, rifampicin, and pyrazinamide-and ethambutol are given.Within an hour, a global urticarialrash erupts (A and B).

A 23-year-old woman presented with medial and lateralpruritic keloids on her right earlobe, which had beenpierced several years earlier. These lesions began to developduring the patient’s pregnancy 2 years earlier.Keloids also were noted on the presternal region. Thepatient reported that these had begun as pimples thatspontaneously enlarged.

My patient is a 7-year-old girl with multiple plantar warts on both feet.

A 10-year-old boy presents with abdominaldistension that has progressed slowlyfor the past 2 years. The distension,which is painless, does not impair hisdaily activities. He has not observedany changes in bowel or voiding habits.

A 3-year-old boy is brought to the office by his mother. Theprevious evening, she had noticed a single large red spot on the back of histhigh. This morning, his whole body was covered with a similar rash, andhe had a temperature of 38.8°C (102°F). The mother administered 1 doseof acetaminophen at home for the fever; the rash was asymptomatic.

Allopurinol has been usedto treat gout for well over3 decades. In addition,this drug is prescribed toprevent urate nephropathyin patients who are receiving cancerchemotherapy.

For several months, a 59-year-oldwoman has had numerous asymptomaticlesions on her arms andlegs. During this period, she has notbeen exposed to the sun and hastaken no new medications.

A 67-year-old man with poorly controlled type 2 diabetes mellitus presents withleg pain and swelling that began 3 days earlier. Multiple ulcers are noted at thelateral malleolus. His temperature is 38.9°C (102.1°F). Right lower extremitycellulitis is diagnosed, blood samples are taken for culture, and the patient ishospitalized.

What caused these linear, grouped, pigmented papules on a child's back? These symmetrical hyperpigmented patches on a man's face? Test your diagnostic skills.

A 28-year-old woman complains that her acne has worsened since she startedtaking minocycline for the skin condition 6 weeks earlier. She also uses a norgestimate/ethinyl estradiol oral contraceptive, which has an indication for acnetreatment. Numerous small, pruritic, erythematous follicular papules are presenton the patient’s forehead, cheeks, and nose

A 29-year-old woman presents with a painful erosive dermatitis that has spreadin a perioral distribution during the last 2 days. She complains of a low-gradefever and swollen lymph nodes. The patient has a history of atopy; she isotherwise healthy and takes no medications.

During the past few weeks, a 14-year-old boy has noticed blood on the proximalnail folds of the second and third fingers of his dominant hand. He deniesany pain or pruritus. The patient is otherwise healthy and takes no prescriptionmedications.

For 2 days, a 43-year-old woman has had a slightly tender rash on her trunk andextremities. Five days earlier, the patient was given levofloxacin for an upperrespiratory tract infection; because she is prone to yeast infections while takingantibiotics, fluconazole also was prescribed. Her only other medication is an oralcontraceptive, which she has been taking for several years.

For 2 weeks, a 35-year-old woman has had a mass on her hand.Although it was initially painless, it now causes discomfort in the forearm,especially when the patient extends her wrist. She has no history of recenttrauma, illness, or a similar mass.

The parents of a 6-year-old child are concerned about blisterson her hands that erupted 3 days earlier and are spreading. The child isotherwise healthy and had attended a summer day camp. The parents areunaware of any trauma or exposure to allergens or toxic substances.

For several months, a 16-year-old girl has had an asymptomatic papulosquamousdescending linear eruption on 1 leg.

For 3 months, a 57-year-old woman has had a persistent green nail that is occasionallyslightly sore; the nail plate has lifted. Another physician prescribed a7-day course of levofloxacin for a suspected Pseudomonas infection; the treatmenthad no effect on the nail. A subsequent 7-day course of norfloxacin wasalso unsuccessful. The patient is otherwise healthy.

During a routine skin examination,periungual erythema and increasedcurvature of the nail plate are notedin a 78-year-old man. The patient hasemphysema and a smoking historyof more than 50 pack-years. Currently,he requires oxygen support forregular daily activity.

For the past 2 days, an elderly woman has had severe pain in and discharge from the right ear. She has diabetes, which is well controlled with anoral hypoglycemic agent, and eczematous dermatitis.

A 24-year-old woman complains ofa pruritic rash that erupted after shesoaked in a hot tub a few days earlier.The patient is otherwise healthy;her only medication is an oralcontraceptive.

This painful, blistery eruption recentlydeveloped on the hand of ateenage girl. She claims she has hadno other such lesions. What doesthis look like?

The parents of a 6-year-old boy are concerned about the asymptomatic bumpsthat have developed on their son’s abdomen during the last few months.

A 26-year-old man who presentswith acne mentions that he has had“Raynaud’s” for 10 years. His eyelidsare pinkish violet and swollen. Nailfold telangiectases are present,and violaceous papules and scaleoverlie the joints. The patient deniesany other symptoms.

To relieve an itch, have patients ruban ice cube over the affected areainstead of scratching with their fingernails.

For 1 week, a 35-year-old woman’s left ear has been very painful, erythematous,and swollen. There is no history of insect bite or trauma. Her conditionimproved only slightly after the physician she initially consulted prescribedmethylprednisolone and cephalexin.

A 73-year-old woman presents with apainless, nonpruritic rash of recent onseton her right lower ankle. She has nofever, chills, nausea, vomiting, malaise,or other systemic complaints. Her medicalhistory includes fibromyalgia, osteoarthritis,stable angina, and anxiety;there is no history of connective tissuedisease.

Lentigines small, well demarcatedtan or brown macules often encircledby sun-damaged skin can alsoappear on normal skin. Thesemacules, which become more numerouswith advancing age, usuallyappear in groups.

Actinic (solar) keratoses are found on sun-exposed skin of elderly white persons-in particular redheaded or blond patients, who tend to burn frequently and tan poorly. Actinic keratoses are the most common sun-related growths in white persons.

Cutaneous horn is a descriptive rather than diagnostic term that refers to horn projections of tissue that are caused by a variety of neoplasms, including actinic keratosis, warts, Bowen disease, granular cell tumors, Paget disease, sebaceous neoplasms, basal and squamous cell carcinoma, and seborrheic keratosis.

I enjoyed Dr Henry Schneiderman’s “What’s Your Diagnosis?” case of an elderly woman with severe facial ecchymoses from a fall. Would Dr Schneiderman elaborate on several points about that case? This woman did not trip or complain of dizziness before she fell. What caused her to fall?