MedChallenger - Integumentary Disorders

A 6-year-old boy has eczema. He has inflamed, dry, and pruritic areas on his face, trunk, and extremities. He is initially treated with moisturizers and topical hydrocortisone 2.5%. With those measures, he improves, but the itchy, dry erythema on his face persists. Which of the following would be the next step in treating his facial eczema?

tacrolimus topically

A 73-year-old woman presents to you with rash under her breast that she first noticed 3 weeks ago. She said it started under the right breast, but then it spread rapidly to involve the area under both breasts, and now she says it burns and itches. Further questioning reveals recent urinary tract infection treated with trimethoprim/sulfamethoxazole for 1 week. Examination reveals an erythematous intertriginous eruption with satellite pustules beyond the edge of the main infection.

candidiasis

A 36-year-old woman with a history of poorly controlled diabetes mellitus and morbid obesity presents to you with redness, swelling, and tenderness in her left leg following minor trauma 4 days ago. Physical examination reveals a temperature of 38.5°C, blood pressure of 122/80 mm Hg, pulse of 96, and regular respirations of 16/minute.

clindamycin

A 38-year-old woman has returned from a missionary trip to Peru that lasted for 1 year. She helped in the development of an organic farm and was outdoors most of the time. During the last 4 months, she has developed brownish, hyperpigmented macules on the face.

combination of tretinoin, hydroquinone, and fluocinolone

A 75-year-old woman who has diabetes mellitus and is morbidly obese presents to you with an ulceration on her right lower extremity.

compression therapy

A 1-day-old female neonate is found to have a rash above her left eye on examination. She was born at 40 weeks via spontaneous vaginal delivery requiring vacuum assistance. The neonate required blow-by oxygen upon delivery.

fading almost completely within 3 years

A 35-year-old woman who is obese presents to you with a complaint of painful growths in her groin. She states that she has had these growths in the past on many occasions, but they always seem to clear up on their own. The patient denies any other significant past medical history and is not taking any medications. On examination, you note erythematous nodular painful lesions and double comedones. You also note that one of the growths in her groin is large, fluctuant, and very tender.

incision and drainage

A 25-year-old woman presents to you with a painful swollen area at the base of her nail. She tells you that it has been present for 3 days. She recently had a manicure, which involved applying acrylic nails. She is otherwise in good health and is only taking ethinyl estradiol/norgestimate.

paronychia

A 40-year-old woman with a history of hypertension presents to you for a routine follow-up visit. During her examination, you observe that the dorsum of her hand has well-defined, flat, depigmented patches.

pernicious anemia

A 26-year-old woman presents to you complaining of recurring "red rash with a few large bubbles" on her hands and distal arms. She tells you that the outbreaks are worse during sunny weather, but she noticed that she did not experience them when she was on vacation.

phytophotodermatitis

A woman presents to you with a 3-week history of a truncal eruption, which she tells you began with a solitary larger plaque on the flank

pityriasis rosea

A 37-year-old man with a history of attention deficit-hyperactivity disorder presents in the spring with pruritic rash affecting his forearms, chest, and forehead. He believes that the lesions 24 hours after he went to a tanning salon. The lesions are erythematous and papular.

polymorphous light eruption

A patient presents to you with a lesion several centimeters in diameter that has been growing over the last 2 years. It has not improved with steroid ointments.

Bowen disease (squamous cell carcinoma in situ)

A patient presents to you with the complaint of a whitish thick discoloring on his left great toenail. He states that he has intense pain in his great toenail when wearing his new sneakers. On examination, you notice a soft, dry, powdery substance that can be easily scraped away on the left great toenail. A provisional diagnosis of onychomycosis is made based on these findings.

potassium hydroxide wet mount

A 31-year-old woman at 35 weeks of gestation presents to you with multiple, small pink-to-red papules on her abdomen sparing her umbilicus. Thus far, the patient has had no complications with her pregnancy. She notes moderate to severe pruritus on her entire abdomen that extends to her anterior thighs.

pruritic urticarial papules and plaques of pregnancy (PUPPP)

A 55-year-old woman with no significant past medical history presents to you for evaluation of a nail lesion that has been gradually increasing in size over the past several months. She has no pain, pruritus, bleeding, or trauma to the area. She notes no new soaps, detergents, shampoos, chemical exposures, or new medications. She does not take any medications, is not sexually active, and does not have a history of intravenous drug use.

pyogenic granuloma

A 10-day-old boy with lethargy and small vesicles on an erythematous base on his head. He was born at 38 weeks of gestation via spontaneous vaginal delivery to a 16-year-old woman.

refer for further workup, hospital admission, and treatment

A 14-year-old boy with tall stature is asking you about his participation in high school football. He falls in the following percentiles: height is > 99%, weight is 15%, and body mass is is 5%. His blood pressure is 120/65 mm Hg, and his pulse is 80 beats/minute. Examination findings are notable for tall stature, reduced upper-to-lower segment ratio, high arched palate, pectus excavatum, joint hypermobility, scoliosis, and a midsystolic click.

aortic dissection

A 55-year-old man who is HIV positive presents to you with rash on his chest and upper extremities. He states that the rash has been present for 1 week and does not itch. He also complains of high fevers (103 °F) for 3 days and nausea, vomiting, night sweats, chills, poor appetite, and an unintentional weight loss of 5 pounds. He denies cough and chest pain, but he does state he has generalized abdominal pain. On examination, you note multiple red and purple papules and nodules on both his upper extremities and thorax, but the rash does not appear on his palms or soles. When manipulated, the lesions bleed profusely. There are no oral lesions. You also note bilateral axillary lymphadenopathy.

bacillary angiomatosis

A patient presents to you with a lesion that has been present for 1 year. He tells you that it has been slowly growing. He has had several previous similar lesions removed surgically.

basal cell carcinoma

What is most common type of skin cancer in the United States?

basal cell carcinoma

An otherwise healthy, 15-year-old girl presents to you because she is quite concerned about the rash she developed on her arm. She tells you that one of her relatives told her it might be a parasite beneath her skin. The affected area is not raised, painful, or pruritic. She tells you she first noticed the lesion 24 hours ago, and it has not changed in size or appearance.

berloque dermatitis

A 16-year-old boy presents to you for a follow-up visit after a nodular lesion was removed from his left arm. Pathology is compatible with neurofibroma. Physical examination reveals a healing surgical wound and the presence of lesions seen in the Figure.

café au lait macules

A 1-day-old male neonate is found to have tiny white blisters on his face on examination. He was born at 36 weeks via spontaneous vaginal delivery without complication. His mother received no prenatal care. Her physical examination during delivery was normal, she denies any significant past medical history, and her prenatal laboratory results are pending. The neonate has been breastfeeding well and has had 2 wet diapers and 1 meconium stool. His vital signs have been normal since delivery.

routine monitoring

A 45-year-old man with no significant past medical history presents to you for evaluation of an itchy, red-colored rash located on his scalp that has been present for the past several weeks. Upon questioning, he tells you that he has not used any new shampoos, soaps, or medications. He also has not worn any new hats or other headgear. He does not take any medications or have any known allergies.

seborrheic dermatitis

A patient presents to you with central facial erythema and scaling prominent in the nasolabial folds.

seborrheic dermatitis.

A patient presents to you with a 5-year history of a slowly enlarging lesion on his scalp.

squamous cell carcinoma

A 55-year-old man with a history of rheumatoid arthritis presents to you because he is concerned that he has developed a white-colored, depressed patch over his right shoulder (see Figure).

steroid atrophy

A patient who received a kidney transplant several years ago was recently admitted to the hospital for worsening renal function. He was given increasing doses of prednisone and cyclosporine. Following their administration, he developed skin lesions on his chest and arms (see Figure). Routine bacterial and fungal cultures are negative. Which of the following is the most likely diagnosis?

steroid-induced acne

When a patient presents with an acute onset of an acneiform eruption atypical for acne vulgaris or rosacea, other causes should be considered. Which of the following is not known to cause acneiform eruptions?

hydrochlorothiazide

A 20-year-old man who is otherwise healthy presents to you for evaluation of a facial rash that has been present for the past several weeks. He notes no pain, pruritus, or bleeding, and he has not used any topical treatments for this issue.

Start topical tretinoin

Which of the following is true about atopic dermatitis?

A person with this skin inflammation is likely to have a personal history and family history of asthma and allergies.

The most common site of Staphylococcus aureus colonization is which of the following?

anterior nares

A 35-year-old man who does not have any prior medical history presents to you for evaluation of a rash on the dorsal surface of his left upper extremity, distal to the elbow. The patient states that the rash occasionally pruritic but is not painful. The patient says it has been present for the past several weeks.

Initiate therapy with topical steroids.

A 19-year-old man presents for evaluation of a facial rash that has been present for the past several weeks. He notes no pain, pruritus, or bleeding, and he says he has not used any topical medications for the rash.

Initiate therapy with topical tretinoin.

A 55-year-old man who does not have any prior medical history presents to you for evaluation of a pruritic rash located on the flexor surface of his left wrist.

Initiate treatment with a trial of topical steroids.

An 88-year-old man was admitted 4 days ago to a skilled nursing facility under your care. He was transferred from the hospital following a large left middle cerebral stroke. On your initial examination, you noted a 3 × 4 cm grade 2 sacral pressure ulcer. The ulcer had a clean base without significant drainage or surrounding erythema. You asked the nurse to place a semi-occlusive membrane covering on it.

Instruct the nurse to apply a new dressing

A 2-day-old female neonate is found to confluent erythematous macules and papules with centralized pustules on examination. She was born at 39 weeks via cesarean delivery. Her mother received routine prenatal care and has a history of giving birth to a previous child via cesarean delivery.

eosinophils

A 63-year-old man was recently prescribed a short course of oral corticosteroids for a flare-up of his psoriasis. Within a few days of his completing the medication, he developed diffuse erythema and scaling involving most of his body.

He has exfoliative dermatitis.

A 40-year-old woman with no significant past medical history presents to you for evaluation of several months of discolored nails. She notes no other rashes or lesions and no pruritus, bleeding, or pain from the nails. She has no constitutional symptoms. She does not smoke cigarettes, drink alcohol, or use illicit drugs. She does not take any medications or have any known allergies.

Initiate therapy with oral terbinafine

Which of the following is true of atypical moles (dysplastic nevi) like the one seen in this Figure?

Individuals with this type of mole are at increased risk of malignant melanoma.

A 5-day-old male neonate presents to you for a newborn check. His mother says that he is bottle-feeding well, sleeping 3 to 4 hours at a time, and has regular wet diapers and bowel movements. However, she is concerned about a blue-grey pigmented macule on his lower back.

Inform the mother that the discoloration will probably disappear by 12 years of age.

A 50-year-old woman with no significant past medical history presents to you for evaluation of a facial rash that has been present for the past few months. She notes that the rash is not painful, pruritic, or bleeding. She has not used any new cosmetic products, new soaps, or new detergents.

Initiate therapy with metronidazole gel.

Which of the following is correct about squamous cell carcinoma of the skin?

It is frequently preceded by actinic keratoses.

A 55-year-old woman with no previous medical history presents to you after returning from a 4-day trek on the Inca Trail in Peru. She has developed a prominent rash of malar distribution.

Lupus erythematosus

What is the most common cause of allergic contact dermatitis?

Nickel.

A 25-year-old fisherman with an unknown past medical history presents to you complaining of edema, erythema, and pain in his right lower extremity. He tells you he first noticed these problems this morning. Since then, he has watched the erythema spread higher on his ankle and then to his leg. On examination, he is febrile, appears ill, and has erythema and edema to his mid shin. The foot is violaceous on the medial aspect. No wound is found, but there are 2 large bullae that obscure the skin of his foot. Although the foot and ankle are tense, he does have range of motion in his toes and ankle.

Obtain a surgical consult for urgent excision and debridement.

A 3-year-old presents for evaluation of speech delay. He was born at term via cesarean delivery for breech positioning. He had difficulty feeding and spent 3 weeks in the intensive care nursery because of feeding issues. His mother reports that he was tested for Down syndrome because of his feeding problems and some muscle weakness but the test results were negative.

Prader-Willi syndrome

A 24-year-old man presents with an enlarged (3 cm), tender, posterior auricular lymph node. He has had 2 days of fatigue and some malaise. He did not take his temperature, but thinks he was febrile yesterday evening. He has not had any recent night sweats. He is otherwise healthy, and he works as a retail cashier. He is monogamous with a female partner and has not had any recent international travel.

Staphylococcus and Streptococcus infections

A 63-year-old woman with diabetes complicated by peripheral neuropathy has a 1.5-cm ulceration on the plantar surface of her foot at the first metatarsal head. She has no fever, but her white blood count is elevated at 14,000/mm3. She feels fatigued, and her blood glucose level is elevated at 359 mg/dL. There is some cellulitis surrounding the ulcer and some devitalized skin. Plain x-ray does not show any gas in the soft tissue and there are no clear-cut bone erosions.

Staphylococcus and Streptococcus species

A 25-year-old man presents with a complaint of multiple acne breakouts around his beard. He says it has been happening for several weeks. He states that he seems to get these breakouts when he shaves. Currently, he is using over-the-counter benzoyl peroxide wash with some improvement. Examination reveals multiple papules and pustules over the beard and neck area with bilateral mild cervical lymphadenopathy bilaterally. Potassium hydroxide preparation was performed, and no hyphae were seen. Punch biopsy was performed and the results are pending.

Staphylococcus aureus

A 64-year-old woman has had erythematous plaques with scaling on areas of her skin that are not sun-exposed. When she did not respond to therapies for eczema and psoriasis, biopsy was performed that showed she had mycosis fungoides (MF).

T-cell lymphoma

A 19-year-old woman complains of a lesion on her left thumb that she tells you has been present for approximately 2 months. She does not have any pain at the site. The lesion is 8 mm in diameter, roughly circular and verrucous in appearance. After trimming some superficial callous, punctate blood vessels are visible.

The lesion is a wart, and treatment is optional because most warts will spontaneously resolve.

A 16-year-old girl presents to you with multiple pink, scaly skin eruptions on her upper torso. She states that she had a 2-cm eruption on her chest 1 week before. Other than the presence of the eruptions, her only complaint is mild itching.

The lesions will resolve with no intervention.

A 58-year-old man with a history of hypertension complains of pain, swelling, and redness of his right index finger. Examination reveals a tense, erythematous distal phalanx with an abscess involving the lateral nail space that extends into the pulp of the fingertip. Concerning treatment of this infection, which of the following statements is true?

Treatment includes a first-generation cephalosporin, incision and drainage along the ulnar aspect of the wound, and splinting.

This patient has a long history of lesions on the face and back (see Figure). They occasionally drain pus. He does not have a history of steroid use. Which of the following is the most likely diagnosis?

acne vulgaris

A 42-year-old woman from East Europe has been recently diagnosed with pulmonary tuberculosis. She is receiving treatment with isoniazid, rifampin, ethambutol, and pyrazinamide, and her sputum has become negative at 8 weeks. She is complaining of generalized fatigue, persistent weight loss, and skin hyperpigmentation, predominantly on her face.

adrenal insufficiency

A 20-year-old woman received multiple cat bites on her forearm 2 weeks ago. She was treated with systemic and topical antibiotics. Her condition initially improved, but then it began to worsen 2 days later with increasing pruritus.

allergic contact dermatitis.

A 47-year-old man with no significant past medical history presents to you for evaluation of circular bald spots that have appeared on his scalp over the past several weeks. His scalp does not itch, is not painful, and he has no skin rash or constitutional symptoms. Upon questioning, he tells you that he has not used any new soaps, detergents, or shampoos. He does not take any medications. He is not sexually active and has no prior history of sexually transmitted infections.

alopecia areata

A 50-year-old man with no significant past medical history presents to you for evaluation. For several months he has had progressive hair loss. He notes no scalp/skin rashes or nail changes. He has no constitutional symptoms. He does not smoke cigarettes, drink alcohol, or use illicit drugs. He does not take any medications or have any known allergies.

androgenic alopecia

A 25-year-old woman who rides horses presents to you complaining of rash on her left foot with intense itching for 1 week. She has used over-the-counter antibiotic ointment as well as cortisone cream with no relief. She owns several horses and dogs. Her general health is unremarkable, and she is not taking any prescription medications. She has no known allergies. Examination reveals a 2-inch, serpiginous erythematous lesion on the dorsal aspect of her left foot. There are surrounding vesicles with yellow discharge on the surface.

cutaneous larva migrans

A 32-year-old woman presents with an intensely pruritic rash on her neck, shoulders, elbows, upper back, and knees, and she also complains of watery diarrhea. She denies myalgia, nausea, vomiting, fever, chills, and any recent travel. She has a past medical history of type 1 diabetes mellitus that is well controlled with insulin. She also has a long-term problem with occasional abdominal pain that gets worse after eating.

dapsone

A 40-year-old Mexican man presents to you with diffuse rash and large, hypopigmented macules and plaques that are present on his thighs and face. The lesions have decreased sensation to touch, heat, or pain. The patient also complains of muscle weakness and numbness in his hands and feet.

dapsone plus rifampin

A 75-year-old man with well-controlled diabetes mellitus developed a laceration on his right lower extremity (see Figure). It happened 3 weeks ago.

debridement

At a well-child visit, you notice a dark lesion on the patient's leg. The mother tells you that it has been present since birth. The lesion covers the patient's entire ankle.

development of melanoma

A 32-year-old man presents to you complaining of small rose-colored dots all over his chest and back. He tells you that since this morning it seems like some of the dots are coming together to form larger ones. The only other symptom he has is low-grade fever. You review his medical history and note that he was presumptively treated for syphilis during his last visit 1 week ago.

drug-induced exanthematous eruption

A patient presents to you with an intensely pruritic recurrent vesicular eruption on the hands.

dyshidrotic eczema.

A 25-year-old man presents with a complaint of multiple acne breakouts around his beard. He says it has been happening for several weeks. He states that he seems to get these breakouts when he shaves. Currently, he is using over-the-counter benzoyl peroxide wash with some improvement. Examination reveals multiple papules and pustules over the beard and neck area with bilateral mild cervical lymphadenopathy. Potassium hydroxide preparation was performed, and no hyphae were seen. Punch biopsy was performed and the results are pending.

folliculitis barbae

A 32-year-old man has had several days of sore throat, malaise, and a maculopapular erythematous rash on his trunk. He takes no prescription medications on a daily basis, and his only medical history is an inguinal hernia repair. His recent travel includes a cruise to the Caribbean that he admits included getting drunk on several occasions and engaging in casual sex.

fourth-generation HIV assay

A 68-year-old woman with no past medical history presents to you with a cut on her finger that she sustained while chopping vegetables 3 days ago. She says that the cut appeared clean, but it has now become red and painful. On examination, the wound edges are edematous and erythematous, but no pus can be expressed. Her finger and distal hand are edematous, and there is red streaking from the wound to her proximal hand.

group A beta-hemolytic streptococci

A 72-year-old healthy man presents to you with an area of well-demarcated erythema, warmth, and discomfort on the face. What is the most likely etiologic pathogen of this patient's symptoms?

group A beta-hemolytic streptococci

A 74-year-old man with a history of diabetes mellitus and hypertension is complaining of blistery, painful lesions on the dorsum of his hands.

hepatitis C virus infection

An older man presents to you for evaluation. He tells you he was riding his motorcycle over a bright sunny weekend, and, 2 days later, he developed discrete erosions on his lip.

herpes simplex virus infection

A patient presents to you after acutely developing a painful vesicular eruption on one side of his face.

herpes zoster virus (shingles)

A 35-year-old woman who is obese presents to you with a complaint of painful growths in her groin. She states that she has had the growths in her groin in the past on many occasions, but they always seem to clear up on their own. The patient denies any other significant past medical history and is not taking any medications. On examination, you note erythematous nodular painful lesions and double comedones.

hidradenitis suppurativa

A 56-year-old former intravenous drug user has a positive hepatitis C antibody during screening. Reflex polymerase chain reaction detected hepatitis C viremia. His physical examination shows lesions suggestive of porphyria cutanea tarda.

hydroxychloroquine

A 50-year-old woman presents to you for an annual physical examination. You note the following cutaneous finding.

hyperlipidemia

A 54-year-old man with known systolic heart failure presents to you with a large area of cellulitis across his upper back that has extended to his left shoulder. He states that it developed over 1 day and has been stable for 2 days since then. On initial examination, he is febrile with a temperature of 38.6 °C, appears fatigued, and is borderline orthostatic with mild, resting tachycardia. No abscesses or bullae are seen on examination, and no additional areas of cellulitis are found. How would you most likely manage his condition?

inpatient admission for broad-spectrum antibiotics while awaiting culture results

A patient presents with a rash of unknown duration on her arms, trunk, and back. She complains that the rash seems to occur every summer but disappears in the winter. Physical examination reveals multiple, hypopigmented patches with sharp borders and fine scales. Biopsy was performed and microscopic analysis reveals multiple, short, blunt hyphae.

ketoconazole shampoo

A 40-year-old Mexican man presents to you with diffuse rash and large, hypopigmented macules and plaques that are present on his thighs and face. The lesions have decreased sensation to touch, heat, or pain. The patient also complains of muscle weakness and numbness in his hands and feet.

leprosy

A patient presents to you with a 3-week history of an 8.0-mm diameter, dark-black and brown- to red-colored, slightly elevated, asymmetric lesion with an irregular border on his right arm. The patient states that the lesion began as a small spot on his arm that just recently began increasing in size and bleeds on occasion.

lesion thickness of 2.25 mm

A 52-year-old man with a history of hypertension and hyperlipidemia develops gout and was treated with oral colchicine. Subsequently, he was started on oral allopurinol for correction of his uric acid. About 2 weeks after starting allopurinol, he develops palpable purpura in both of his lower extremities.

leukocytoclastic vasculitis

A patient presents to you who habitually and unconsciously rubs his elbow.

lichen simplex chronicus

A 25-year-old woman with a history of intermittent asthma has recently returned from a vacation trip to Cancun. During her trip, the patient developed prominent blisters on the dorsum of her hand.

lime juice

A man presents to you with a history of brown spots, which he tells you he has had since birth. However, he explains that he has noticed increasing numbers of these fleshy tumors over the past several years.

neurofibromatosis

A 20-year-old college student presents with a 2 cm boil on the right side of his neck. He believes a new shirt he was wearing for the last few days caused friction and the development of the boil. He is concerned because his roommate was recently admitted to the hospital for a leg abscess caused by methicillin-resistant Staphylococcus aureus (MRSA). The patient is healthy. He has no other complaints except local pain. Vital signs are normal. He has a 3 cm fluctuant, tender, erythematous mass in the posterior portion of the neck on the right. You incise and debride the lesion.

no antibiotic

A 42-year-old man presents to you in November with severe pruritic rash on his upper arms. He states that this is the second time he has experienced this rash. During the first time, the rash was much milder, and it resolved soon after going on vacation in the Caribbean and using over-the-counter topical corticosteroids. He has no other medical history, including no history of seasonal allergies.

nummular dermatitis

A 93-year-old woman is readmitted to a skilled nursing facility after a 10-day hospital stay for sepsis with a urinary source. She has bilateral heel pressure ulcers--stage 2 on the left and stage 3 on the right--as well as a right-sided stage 2 trochanteric pressure ulcer. She ate little while in the hospital and lost 12 pounds.

nutritional supplementation with protein or amino acids

A morbidly obese man presents to you after developing velvety, hyperpigmented lesions in the posterior aspect of his neck. He has been told by his relatives that this may be associated with cancer, so he is seeking your advice.

obesity

A 15-year-old girl has had acne for 1 year. Initially, she had open and closed comedones, and she was treated with topical adapalene. She returns because she feels that, while she initially improved, in recent months her condition has worsened. On examination, she has some open comedones but also many erythematous papules and several pustules. She is otherwise healthy and not taking any medications. Which of the following is the most suitable next step in her acne treatment?

oral doxycycline in combination with topical benzoyl peroxide and topical adapalene

A child presents to you after rapidly growing the lesion seen in this Figure within the first year of life. Which of the following is the treatment of choice if the lesion begins to obstruct the child's vision?

oral propranolol

A 32-year-old woman with diabetes presents with a 3-day history of erythema, warmth, edema, and pain of her right forearm. Examination shows that she is afebrile with normal vital signs and has an edematous area of erythema with indistinct borders on her medial forearm, not extending to the hand, with no areas of fluctuance or induration. She has full active and passive ranges of motion, as well as normal sensation and pulses. How should her condition be managed?

outpatient management with cephalexin

A patient presents to you for evaluation of an enlarging pigmented lesion he found on his skin. Biopsy reveals that this lesion is malignant melanoma. What characteristic is most strongly related to the patient's prognosis?

thickness of the lesion

A 50-year-old woman with no significant past medical history presents to you for evaluation of a rash on her scalp that has been present for the past several weeks. She tells you that it is intermittently itchy, but that the rash does not appear anywhere else on her body. She has not started using any new soaps, detergents, or medications. She has had no new exposures to chemicals or plants. She does not smoke cigarettes, drink alcohol, or use illicit drugs. She does not take any medications.

tinea capitis

An 11-year-old boy presents to you with the focal hair loss seen in the Figure. The hair loss was first noticed about 5 to 6 weeks ago. The child's father tells you that he has been losing his hair over the past 5 years. The area of hair loss is highly pruritic in the child. His hair is not falling out in clumps. There is no history of psychiatric disease. The area of hair loss does not appear to come and go.

tinea capitis

A child has developed a slowly spreading, scaly plaque on her face. She sleeps with her cat, which has been scratching itself lately.

tinea faciei

A 55-year-old postmenopausal woman presents to you for evaluation after she noticed a diffuse, pruritic rash that started without provocation 1 day earlier. During today's visit, she tells you that the rash is starting to improve. She notes no lip or tongue swelling and has no difficulty breathing or chest pain.

urticaria

A young woman developed a pruritic eruption that rapidly moved from area to area on her skin. This history is classic for what disease?

urticaria

A mother presents to you after she saw lesions on her child's hands that she says has been present for the last 2 months. The mother tells you that her other daughter has similar lesions on her hands.

verruca vulgaris

A patient with very dry legs presents to you after having recently developed a rash.

xerosis with xerotic eczema