Dermatology

Erythematous patches and papules on the knuckles; a slowly enlarging papule on a finger; a painful ulcer on the thumb; rough, thickened skin around the metacarpophalangeal joints; symmetric, soft, tan papules....

Generalized weakness and malaise have bothered a 44-year-old woman for a few days. The patient has several large, flat facial lesions that have been present for years; she has never consulted a physician about them.

An asymptomatic acneiform eruption; persistent, mildly pruritic papules; a pustular rash that resists antibiotics--can you identify the disorders pictured here?

A 50-year-old woman was concerned about a nonhealing, painful lesion on the medial aspect of the left side of the nasal bridge. The lesion had been present for several weeks. The patient believed that a "cyst" had developed in the area. She had been attempting to remove it manually.

A 49-year-old man presented to the emergency department with hematemesis and 2 episodes of melena. Examination findings included resting tachycardia and melenic stool. Blood pressure was 95/50 mm Hg. Multiple raised, soft, bluish 0.3 to 1 cm lesions were noted on the trunk and extremities.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Researchers in the Netherlands investigating the relative risks of common infections in patients with type 1 or type 2 diabetes mellitus (DM1 or DM2, respectively) determined that both groups are at increased risk for lower respiratory tract infection, urinary tract infection, and skin and mucous membrane infection.

Abstract: In addition to causing pulmonary disease, infection with Mycobacterium tuberculosis can result in a wide range of extrapulmonary manifestations, including abdominal involvement. Patients with acute tuberculous peritonitis typically present with fever, weight loss, night sweats, and abdominal pain and swelling. Intestinal tuberculosis is characterized by weight loss, anorexia, and abdominal pain (usually in the right lower quadrant). A palpable abdominal mass may be present. Patients with primary hepatic tuberculosis may have a hard, nodular liver or recurrent jaundice. The workup may involve tuberculin skin testing, imaging studies, fine-needle aspiration, colonoscopy, and peritoneal biopsy. Percutaneous liver biopsy and laparoscopy are the main methods of diagnosing primary hepatic tuberculosis. Treatment includes antituberculosis drug therapy and, in some cases, surgery. (J Respir Dis. 2005;26(11):485-488)

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

A 35-year-old man with type 1 diabetes has had an asymptomatic rash on the lower extremities for the past several months. He denies trauma and recent illness. He has tried multiple "home remedies," but the rash has persisted. He smokes and drinks alcoholic beverages occasionally.

Progressive cough and dyspnea of 2 months' duration prompted a 23-year-old man to seek medical attention for the fourth time. On previous emergency department visits, he had received antibiotics, which failed to relieve his symptoms.

A 36-year-old woman with a history of HIV disease presented for evaluation of dyspnea of 1 week's duration. She had been taking trimethoprim-sulfa- methoxazole for Pneumocystis carinii pneumonia prophylaxis. Because of a presumed skin reaction to this medication, dapsone was recently substituted.

Some studies suggest that orally administered dapsone is effective for infections caused by spider bites (eg, brown recluse spiders) in dosages of 4 mg/kg/d for 3 days. Can dapsone be used in children and, if so, at what dosage?

An erythematous eruption on the eyelids, asymptomatic papules on the extremities, an acneiform rash--can you identify the disorders pictured here?

A 34-year-old woman presented with a blistering, intensely pruritic rash that had erupted 3 days earlier. Multiple papular lesions were densely clustered on areas of exposed skin. Excoriations were present, but there was no evidence of bacterial infection.

For 6 months, a 19-year-old woman had had sensitivity to cold. When outside in cold weather, she noticed swelling, erythema, and pruritus of her uncovered hands. After she held a cold drink on her arm for about 5 minutes, urticarial lesions developed on the skin in contact with the drink. The symptoms resolved about 20 minutes after the cold source was removed. She denied angioedema, respiratory symptoms, light-headedness, and tachycardia.

These pinpoint pustules, some with excoriations, and surrounding erythema appeared on the posterior trunk and outer arms of a 15-year-old boy after he had wrapped his upper body in a wool blanket. These lesions were occasionally pruritic, especially on the arms, where most of the excoriations were noted.

This black lesion had been present on the upper back of a 5-year-old girl since birth. The lesion had gradually enlarged to its current size of 1.5 cm. In the past year, 3 satellite black macules had developed in the surrounding area.

Lines of Blashko may represent normal embryonic movements of the skin during embryogenesis.

This 11-year-old boy has a segmental café au lait macule in a zosteriform distribution. Because the presence of such a lesion may signify somatic mosaicism, a careful review of systems and physical examination of affected patients is indicated. The same cautions apply to patients with large (10-cm) café au lait macules. This patient is vigorously healthy.

McCune-Albright syndrome is classically described as a triad of polyostotic fibrous dysplasia, café au lait macules, and precocious puberty. The syndrome may also be accompanied by various other endocrinopathies including hyperthyroidism, acromegaly, hyperprolactinemia, Cushing syndrome, and hypophosphatemic rickets. Some patients may also exhibit hepatic, cardiac, and GI dysfunction.

This 4-year-old boy has urticaria pigmentosa--one of a group of disorders in which mast cells group together in the skin. Patients may have solitary mastocytomas or (rarely) diffuse infiltration of the skin with mast cells.

This is an autosomal recessive syndrome characterized by chromosomal breakage, pancytopenia, and various congenital abnormalities. It is a heterogeneous condition clinically and has been linked to defects in at least 8 different genes. Fifty percent to 65% of affected persons demonstrate areas of hyper- or hypopigmentation. Café au lait macules, like those shown in Figure A in a 9-year-old boy, are seen in approximately 25% of those affected.

The 12-year-old boy in Figure A has one large and one small café au lait macule and a single hypopigmented macule. Solitary café au lait macules may be present in as many as 30% of newborns. They vary in size from a few millimeters to several centimeters. The macules may be inconspicuous until the affected area is exposed to the sun.

A 14-year-old African American boy presented during the winter months with a painless, nonpruritic, periumbilical rash that had been present for approximately 1 month. Initially bluish, the rash had become dark brown.