Dermatology

A 65-year-old woman presents with a 1-cm raised, light brown, circular, nodularlesion on the top of her head, which has progressively enlarged during the last6 months. The growth was removed by shave excision; electrodesiccation andcurettage were performed on the base. Pathologic evaluation determined thelesion was a basal cell carcinoma.

A 38-year-old man presented with a fleshy lesion beneath the tip of his penis. He had discovered it about 18 months before the initial evaluation. A second similar lesion resembling a “cauliflower” had appeared several weeks after the first. Both lesions had grown and had begun to bleed during intercourse.

For 5 years, a 54-year-old woman had been bothered by an intermittent dermatitis on her left hand and wrist. The rash had remained constant during the past year. The patient, a hairdresser, usually wears gloves when she works. Moderate erythema and flaking were noted on her hands.

A 40-year-old man presented with a 5-year history of progressively increasing bilateral leg swelling that was neither painful nor pruritic. There was no history of dyspnea, jaundice, or groin surgery. The patient reported multiple previous episodes of superimposed cellulitis, which were treated with antibiotics. There was no family history of similar illness.

Bullae had recently appeared on the dorsa of the hands and fingers of a 46-year-old man. His medical history was significant for alcoholism, discoid lupus erythematosus (DLE), and hepatitis C. Systemic lupus erythematosus (SLE) was ruled out; the patient’s symptoms did not meet the American Rheumatism Association criteria for SLE.

A blue-black nodule has been present next to a 19-year-old woman’s left eyesince birth. After recent accidental trauma, the lesion has enlarged.

Dry, pruritic, scaly skin was noted on a 65-year-old woman who came to the emergency department with bronchitis. She reported that her skin had had this texture all of her life.

The parents of a 6-year-old girl were concerned about the hyperpigmentation of their child’s fingers. Two weeks earlier, lime juice was accidentally spilled on the patient’s fingers during a barbecue on a sunny beach. By the following morning, the affected digits had turned red. A few days later, the erythematous areas became hyperpigmented.

Several lesions had appeared 1 week earlier on the left distal thigh of a 47-year-old woman. The affected area featured erythema with irregular faded borders and central redness with very fine papules over the L3 dermatome. The indurated and tender central areas suggested inflammation or necrosis. There were no vesicles and there was no drainage.

A painful, 4.8-cm nodule developed over 3 weeks on the face of a 76-year-old man. The results of a generous shave biopsy suggested a keratoacanthoma, a benign but locally destructive tumor that typically arises abruptly and enlarges rapidly. Curettage and desiccation were subsequently performed.

A 12-month-old infant is brought to your office for evaluation of ared, swollen left index finger, which her parents first noted the prior evening.The mother denies any known trauma or recent illness. She tells you that theinfant is slightly fussy and is not taking her bottle as well as usual.

The abrupt onset of widespread cutaneous eruptions prompted a 66-year-old man to seek medical evaluation. The patient had had chronic myelogenous leukemia for 5 years.

A network of purplish pink lesions recently developed on a 28-year-old woman’sarms and legs. The asymptomatic rash becomes more prominent with exposureto cold. The patient denies fever, aches, arthralgias, oral erosions, chestpain, and photosensitivity.

A 47-year-old woman who wasseropositive for HIV-1 presented tothe emergency department with severemaculopapular, erythematouseruptions. Her antiviral regimen hadrecently been changed from zidovudine, 300 mg bid; lamivudine, 150 mgbid; and saquinavir, 600 mg tid, tolamivudine, 150 mg bid; stavudine, 40mg bid; and nevirapine, 200 mg/d.

The sudden onset of a petechial rashon the upper and lower extremities,ecchymosis of the tongue, and anepisode of epistaxis prompted a78-year-old woman to seek medicalevaluation. She reported having takenone of her husband’s quinine pills aday earlier to alleviate leg cramps.The patient was otherwise in goodhealth and took no other medications.

This lesion on her knee had been present for 5 years, reported a 22- year-old woman. It was not related to any trauma; its size had not changed, but occasionally it became darker or lighter.

For 2 years, an asymptomatic mass had been present in the left iliac crest area of a 6-year-old boy. The soft, rubbery, lobulated mass was not attached to the overlying skin or to the underlying structures.

Leprosy, or Hansen disease, had recently been diagnosed in a 39-year-old man. He presented to the tropical disease unit of Harare Hospital, Zimbabwe, for follow-up.

A 72-year-old woman presented to the emergency department with epistaxis and generalized telangiectasia. The patient was known to have Rendu-Osler-Weber syndrome, or hereditary hemorrhagic telangiectasia, an autosomal dominant disorder that is associated with arteriovenous fistulae of many organs.

The sudden onset of a petechial rashon the upper and lower extremities,ecchymosis of the tongue, and anepisode of epistaxis prompted a78-year-old woman to seek medicalevaluation. She reported having takenone of her husband’s quinine pills aday earlier to alleviate leg cramps.The patient was otherwise in goodhealth and took no other medications.

Perspiration in areas of skin redundancy-such as under pendulous breastsand in the groin-can predisposepatients to irritant or candidal intertrigo.

Round, smooth, bald areas had recently developed on the neck and chin of a 32-year-old man. No other areas of the body were affected. The patient had a lifelong history of chronic anxiety.

I read with interest Michael Rothstein’s Practical Pointer,“No More (Foot) Fungus Among Us” (CONSULTANT, August2002, page 1185).

A 59-year-old woman presented for a routine physical examination. She had no physical complaints and took no medications. During the physical examination, bilateral, flat, slightly elevated, yellowish cutaneous lesions were noted above and below the skin folds of the patient's eyelids.

Cutaneous lesions can develop in anumber of pulmonary diseases, suchas tuberculosis and sarcoidosis, as wellas in other diseases that may have pulmonaryinvolvement, such as Wegenergranulomatosis, collagen vasculardiseases, varicella, and pneumococcalinfections. In many cases, knowledgeof the clinical and histologic characteristicsof the skin lesions associatedwith these diseases can greatly facilitatediagnosis.

A 32-year-old previously healthywoman presents to the emergencydepartment with skin lesions, suprapubicpain, and generalized myalgia of1 week’s duration. Trimethoprim-sulfamethoxazolefor a presumed urinarytract infection is prescribed, and thepatient is discharged. The symptomspersist; she is hospitalized 2 days later.

The family of a 50-year-oldalcoholic man brings him to youroffice. They are concerned abouthis health and note that they had notseen him for several months beforehe reappeared. The patient complainsof generalized weakness, fatigue, andbleeding gums.

ABSTRACT: Systematic palpation can detect a trigger point; often, muscle spasms or a nodule will be present. Injection of the trigger point with a local anesthetic usually reduces pain promptly; the procedure can also effect long-term pain relief and increased range of motion. However, pain may recur and even worsen 1 to 3 days after an injection-either because additional injections are needed or because the trigger point was not completely injected. To maintain pain relief and improve strength and range of motion in the affected muscle following injection, recommend stretching exercises, physical or massage therapy, or rest. Trigger point injections can be associated with adverse effects (eg, temporary numbness, injection site irritation, and dizziness); complications include vasovagal syncope, skin infection, and compartment syndrome.

For the past several weeks, a 54-year-old man has had progressivelyworsening abdominal pain and general achiness.He has no nausea, vomiting, diarrhea, or fever and no historyof trauma.

Satellite lesions are usually associated with Candidainfections but not with Bowen disease.