Dermatology

Left eyelid swelling and drooping, which had been worsening slowly over the last 5 to 6 months, prompted a 77-year-old man to seek medical evaluation. There was no pain and no discharge from the eye. The patient stated that his vision was not adversely affected, and he denied diplopia. There was no history of ocular injury or surgery.

A 48-year-old man requested medical evaluation of the multiple spots that gradually appeared on his legs over the past 5 years.

Two weeks after the subcutaneous injection of 0.5 mL of varicella vaccine in a 2-year-old girl's left arm, a nonpruritic rash developed on the child's upper abdomen and left forearm. She had no fever. The lesions subsided after 5 days.

This 7-month-old infant had light red macules on the glabella that were first noted at birth. By the time the child was 2 years old, the lesions were only faintly visible.

An 18-month-old girl was noted to have somatic overgrowth, macroglossia, macrostomia, fading telangiectatic nevi over the glabella and eyelids, vertical creases on the earlobes, a short nose with anteverted nares, and a long philtrum. She also had an ejection systolic murmur best heard at the left mid- and upper sternal border, compatible with an atrial septal defect.

A 2-week history of diarrhea mixed with bright red blood was the presenting complaint of a 40-year-old man who was seropositive for HIV. Stool studies and culture results were negative for microorganisms. Colonoscopy demonstrated only the raised vascular lesion seen here in the sigmoid colon, which may have been responsible for the bleeding.

A 42-year-old woman sought medical advice for a facial rash of 4 weeks' duration. She denied any drug allergies, changes in her routine, or use of new laundry products.

A 67-year-old woman presented with a painful genital ulcer. She denied new sex partners and previous genital lesions.

Purplish skin lesions appeared on the back and trunk of a 34-year-old homosexual man with HIV-1 disease. The spots had been growing larger over the past several weeks.

This 6-year-old child presented with a painless mass on his lower lip. The mass had increased in size slowly during the previous 2 months.

n asymptomatic pink lesion measuring approximately 1 cm in diameter appeared on this 80-year-old woman's right cheek 3 weeks before this picture was taken.

This 7-year-old presented with a pink, raised lesion on her upper left eyelid. The 1-cm lesion contained tiny vesicles and showed eccentric central clearing.

Seen here is an ulcerated tumor with irregular borders on the left foot of a 37-year-old man. He said the tumor had developed several years ago.

Ten days after ballet practice, a 9-year-old girl noticed a nonpruritic, petechial rash on her lower legs. Swelling of the ankles and knees was also apparent. The patient was afebrile, otherwise healthy, and had no abdominal pain. There was no family history of blood dyscrasias. The patient was taking no medications.

For more than 20 years, a 55-year-old man had a faintly erythematous, papulosquamous rash with arciform borders on his groin and waistline. The rash had been treated with a variety of medications. Topical and oral antifungals and antibiotics and topical corticosteroids had been used but to no avail. No laboratory tests had been performed.

Flat, tan-pink patches on his lower legs disturbed a 52-year-old man. The lesions had visible, nonpalpable petechiae, which did not blanch on diascopy; telangiectasia and inflammatory vasodilation, therefore, were excluded from consideration.

A 51-year-old woman with severe migraines sought evaluation of a dozen round black macules on her hands, forearms, and legs. A few of the lesions had first appeared 1 year earlier; the remainder had erupted since then.

Flesh-colored to red-brown nonpruritic papules developed most prominently on the elbows, forearms, and knees of a 2 1⁄2-year-old boy. The rash was preceded by a low-grade fever and mild, upper respiratory tract symptoms.

A 46-year-old man complained of “irritation” in the groin of several months' duration.

A 67-year-old man was concerned that the peeling lesion near his eyebrow was cancer.

Brown-black discoloration and a soft, velvety papillomatosis of the axillary, inguinal, genital, and neck areas were seen in a 46-year-old man. He had hypertriglyceridemia, for which he had recently begun taking nicotinic acid. After a few days of therapy, he noticed the onset of this asymptomatic hyperpigmentation.

These lesions are always present at birth. They consist of mature dilated capillaries and represent a permanent developmental defect. They are red to purple, macular, and sharply circumscribed. They are usually unilateral and may occur anywhere on the body, although they tend to favor the face. Unlike salmon patches, port-wine stains do not fade; in fact, they tend to darken and become nodular with age.

For 2 days, an 80-year-old woman had left ear pain and a rash around the ear canal and pinna. She also complained of pain and small papules in the back of her pharynx on the left side. She had no fever or chills and no rash elsewhere on her body. She denied drainage from the ear and previous ear infections or skin eruptions. Several years earlier, she had undergone surgery and chemotherapy for lymphoma but had been well since then.

A 75-year-old Hispanic woman presented with a slowly growing, asymptomatic facial lesion of about 3 years' duration.

Gross cysts (palpable fluid-filled macrocysts) are the most common lumps found in the breast. Cysts vary tremendously in size and number and may be microscopic or macroscopic.

A 21-year-old man slept in a car in upstate New York for three winter nights. Discomfort and swelling of his toes developed, which progressed to marked discoloration of the digits.

A 69-year-old woman, who was being seen regularly for treatment of psoriasis, was noted to have numerous open comedones on the sides of her face in association with photodamaged skin.

After having been bothered by these lesions for the past 9 months, a 27-year-old woman described the eruption as "itchy bumps under my arms."

Worsening episodes of pain and bleeding from the lesion on the dorsum of her foot brought a 16-year-old girl to her physician's office. The spot had gradually enlarged since she first noticed it about 3 years earlier.

A 23-year-old man complained of unsightly “flat warts” all over his chest. These lesions first appeared in early adolescence. The clinical suspicion of epidermodysplasia verruciformis was confirmed by a biopsy.