Derm
A 67-year-old woman presents to a dermatologist with painful vesicles on an erythematous base. He diagnoses her with herpes zoster. In what type of configuration would her lesions be expected to be found?
Dermatomal grouping
A 50-year-old Caucasian man presents with an itchy lesion on his left leg. He reports that it has been recurrent for several years, always appearing at the same site. On examination, a coin-shaped, crusted lesion is noted on his left pretibial surface. Dx?
Nummular dermatitis
A 17-year-old girl presents with a rash. She states she noted a single oval patch several days before a more generalized rash erupted. She indicates that the rash mildly itches. On physical examination, the initial lesion appears as an erythematous (salmon-colored) plaque with a collarette on the trailing edge of the advancing border. You note a fawn-colored rash that follows the cleavage lines on the posterior trunk. This rash is most prevalent on the trunk, and the proximal upper and lower extremities. Dx?
Pityriasis rosea
A 55-year-old man states that he recently noticed that he has started to flush easily and his nose appears unusually large. Additionally, during an appointment with his eye specialist the month before, he was prescribed medication for blepharitis and keratitis. Dx?
Rosacea
A 45-year-old woman presents with a lesion on her calf. She states that she has had it for a while and that it has not gotten bigger, but it does not heal and it bleeds occasionally. On exam, the lesion is a pink, sharply demarcated, scaling plaque. Dx?
Squamous cell carcinoma
A 69-year-old Caucasian woman presents with a painful lesion on her lip that has been rapidly increasing in size and bleeding for the past month. She gives a long history of sun exposure and several blistering sunburns in her adolescence. On examination, there is a tender, pink papule 2 cm in diameter on her lower lip. Dx?
Squamous cell carcinoma
An 18-year-old man presents with a rash. He states that the rash began a few weeks ago and it has worsened over the past 2 weeks. He denies fever, chills, nausea, vomiting, or weight loss. He also denies recent travel or illness. He has no significant past medical history and is otherwise very healthy. Physical exam reveals a well-developed, well-nourished man in no acute distress. He has areas of hyperpigmentation on his back and chest. A scraping taken from the back area shows orange fluorescence under UV light. What is the most likely cause of this patient's symptoms?
Tinea versicolor
A 15-year-old boy is being treated at the dermatologist for lesions on his cheeks, forehead, chin, upper chest, and upper back with a history that has been progressively getting worse. Upon physical exam, open and closed comedones are present on the patient. Additionally, inflamed papules and some scarring are present. All labs are within normal limits. Dx?
Acne vulgaris
A 16-year-old boy presents to his primary care physician with skin lesions. The lesions are scattered over his forehead, nose, and chin. He denies facial flushing and pruritus. The following presentation is seen on examination. Refer to the image. (acne) Dx?
Acne vulgaris
A woman presents with her 17-year-old son due to concerns about his face. She states that he seems to break out in a rash on his face and it has been getting worse over the last 3 years. On physical examination, you note multiple closed comedones and papulopustules covering his cheeks, forehead, and chin. Dx?
Acne vulgaris
An 65-year-old man is being treated at the dermatologist for a lesion on his face for the past 5 weeks that will not go away. Additionally, the patient has a history of staying out in the sun, as he lives in Florida. Upon physical exam, a 0.6 cm macule that appears flesh-colored and slightly hyperpigmented is present on his right cheek. Upon palpation, the macule feels like sandpaper and is tender to the patient. All labs are within normal limits. Dx?
Actinic keratoses
A 45-year-old woman has a history of laying out in the sun at her home in Florida since she was a teenager. She states she noticed a lesion on her cheek for the past few weeks and it will not go away. Upon physical exam, the patient has a wart that appears to be elevated and pink with a sandpaper texture. Dx?
Actinic keratosis
A 55-year-old man presents with lesions on the top of his head. He noticed them about 6 months ago and did not think much about them until more of them appeared. Physical examination of the scalp shows that he is slightly balding and has scattered multiple lesions that appear to be <1 cm in size. The lesions are yellow-brown, dry, and scaly. Upon palpation, the lesions have a rough, coarse texture and are tender. Dx?
Actinic keratosis
A 22-year-old man presents with a 1-day history of painful blisters at the right angle of his mouth. He has had tingling and burning sensations at the site for 3-4 days. He has no significant past history. On examination, his temperature is 99.5°F, but other vitals are normal. Multiple small vesicles are seen at the right angle of the mouth. There are no such lesions elsewhere. TOC?
Acyclovir
A 27-year-old woman presents with painful, itchy blisters on her genitals. She is G0/Ab0/P0, has a regular monthly cycle (29/5); menarche was at 13, and she has had a steady partner for 2 years. She does not use any method of birth control, including condoms. She states that both her partner and she are monogamous, and he does not have any symptoms. 2 days earlier, she had been feeling sick. She was taking OTC aspirin, but still has an elevated temperature of 37.5°C. On exam, you palpate enlarged lymph nodes in the inguinal area and see multiple vesicles on her labia and perineum; some are ruptured and some are crusted over. There is no vaginal discharge, and the rest of the pelvic exam is inconspicuous. What is the proper treatment for this condition?
Acyclovir
A 3-year old boy is brought to the pediatrician with a 2-week history of symptoms of an itchy, red "wound" on the right knee. The mother ignored the wound initially, assuming that the boy got injured while playing on the street, but it did not heal and seems to have worsened. On examination, there are a few intact vesicles and a few ruptured vesicles covered with honey-colored crusts. You suspect non-bullous impetigo. Tx?
Antibiotic ointment
A 75-year-old woman presents with a 2-week history of dryness and itchiness of her legs. She reports that it has been recurrent for the past 2 winters. On examination, you note pretibial erythematous fine cracks. Dx?
Asteatotic eczema
A 20-year-old African-American woman presents with very itchy rashes on her arms. She reports that they have been recurrent for as long as she can remember. She is an asthmatic and on ventolin (salbutamol) inhaler. On examination, you note erythematous maculopapular lesions with hyperpigmentation and lichenification in the antecubital fossae bilaterally. Dx?
Atopic dermatitis
A 3-year-old girl presents with lesions on the flexural aspect of her arms. She is not taking any medications. Her mother states that symptoms appeared when they were traveling to the mountains for a winter trip less than 1 week prior to presentation. On clinical exam, well rounded, erythematous, papular lesions are present; there is weeping and scaling. What is the most likely diagnosis?
Atopic dermatitis
An 8-year-old girl presents with an itchy rash. The mother says she has observed the child itch off and on over the last 4 months. "She'd be fine if I could just get her to stop itching," the mother says. The child is on no medications; she is well positioned on the growth curve, and she is otherwise healthy except for occasional bouts of exercise-induced asthma. Physical exam reveals generally dry skin and areas of mild erythema and excoriation, largely confined to the antecubital and popliteal fossae. As the doctor prepares to step outside, the mother asks if the fact that she was treated for syphilis prior to her pregnancy with this child could have anything to do with this. What condition does the girl most likely have?
Atopic dermatitis
A 55-year-old man presents with a non-healing, inflamed 'pimple' on his cheek. It has been present for 5 months, and it has recently started to bleed when he shaves. On physical examination, you note that he has fair skin, blue eyes, and a ruddy complexion. There is a raised lesion on the left cheek measuring 2.5 cm in diameter that appears rolled, with pearly pink borders and telangiectasias. Image 6-1 (courtesy John Hendrix, MD) depicts the lesion. Dx?
Basal cell carcinoma
A 59-year-old fair-skinned Caucasian woman presents with a lesion on her eyelid that has been growing slowly for the past 6 months. She reports that she has been an avid gardener most of her life. On examination, you find a nontender nodule with a pearly border on her right lower eyelid. Dx?
Basal cell carcinoma
A patient comes to see you for a growth on his forearm. He has had it for 7 years and is concerned that it may be enlarging. You observe a well-circumscribed, pink, slightly pigmented, raised nodule about 1cm diameter. The center appears slightly ulcerated. Dx?
Basal cell carcinoma
A 62-year-old woman well known to you presents with a severely itchy rash. The patient's medical history includes Parkinson's disease, which was diagnosed around 7 years ago. The patient thought that the rash was just eczema initially, but the areas have morphed into severely tense, large blisters; they are extremely pruritic to the patient. On examination you note multiple bullae 1 to 3 cm in size that are tense, and appear to be sitting on an erythematous base. The bullae are located on the patient's lower abdomen in both lower quadrants, as well as in the bilateral axillary and inguinal folds. Dx?
Bullous pemphigoid
A 66-year-old woman presents with a rash that has developed over the last 3 weeks; it has been getting worse. She states that her legs began to itch and became red with blisters, she noted that the same thing was occurring on her abdomen about 1 week ago. On physical examination, you note urticarial, inflammatory plaques, as well as papules with blister formation. On her abdomen, you note inflammatory plaques surmounted by tense blisters. Dx?
Bullous pemphigoid
A 23-year-old woman comes to the office for a gynecologic examination. This is her first visit, and she has no complaints. She tells you that she has not had a Pap smear in several years. Her menarche was at 12 years, and she has had regular cycles since then. She has had several sexual partners in the past, but has been with her current partner in a monogamous relationship for 1 year. She reports that she had a chlamydial infection that was treated several years ago, but she denies a history of other sexually transmitted diseases. She has never been pregnant. On physical examination, her cervix appears friable with a slight area of ulceration. There are several perineal and vaginal lesions, which appear as small cauliflower-like projections. The results of the Pap smear, which return in 1 week, show a low-grade squamous intraepithelial lesion (mild dysplasia, CIN I). What factor in this patient's case is most closely correlated with the abnormal finding on the Pap test?
Condyloma acuminata
A 16-year-old female presents with a red, itchy rash on her feet. The patient reports the rash started when she wore her new cheerleading shoes. PMH negative. The patient takes no medication. There is a stocking pattern of vesicles and some crusting. The surrounding area is erythematous. Dx?
Contact Dermatitis
A 15-year-old boy presents with a complaint of small red itchy blisters on his feet and ankles. The blisters began early in the summer when he was attending band camp. He denies taking medication. On clinical exam, there are red papules with some dry scales. The area affected is limited to the foot and ankle area. Dx?
Contact dermatitis
A 40-year-old man presents with a 2-day history of itchy lesions on his face; the onset came after using a new aftershave. On examination, you find erythematous, sharply demarcated, weeping lesions on his cheeks and chin. Dx?
Contact dermatitis
A mother brings her 5-year-old son to your facility presenting with several blisters on his cheek and around his nose. On examination, you note numerous vesicles and bullae containing light yellow fluid on both cheeks with minimal involvement around the nose and several outcrops of vesicles and bullae on his wrists. Tx?
Dicloxacillin orally (Impetigo should be treated with an antimicrobial agent effective against Staphylococcus aureus (β-lactamase-resistant penicillins or cephalosporins, clindamycin, amoxicillin-clavulanate) for 7-10 days.)
A 19-year-old woman presents with a 2-week history of rash. Other than a sore throat that she had last week, she reports being in good health; her sore throat was treated with penicillin. She does not believe that she has come in contact with any type of irritants or any individuals who are sick. On physical examination, you note several target-like lesions on the palms of her hands that are bilateral and symmetric. She indicates that she is on birth control medication. Dx?
Erythema multiforme
A 33-year-old woman presents with a 1-week history of lesions on her face and neck. She works as a cook and dishwasher, and she denies taking any medications. The lesions occurred with the presentation of a sore throat, diarrhea, and fever. On clinical exam, the lesions are well-rounded, red macules, with an iris appearance. A few lesions are also apparent on the buccal mucosa. Dx?
Erythema multiforme
A 21-year-old woman presents with painful bumps on her shins. The patient stated they appeared when she "got the flu last week". She has been using acetaminophen for the discomfort and to manage her flu symptoms. No other medications have been taken. On clinical exam of the anterior aspect of the patient's legs, the nodules appear symmetrical, red, and shiny; they are 3 cm in diameter. Palpation elicits pain. Dx?
Erythema nodosa
A 22-year-old woman presents with a 3-day history of a rash on her legs. On physical examination, several extremely tender indurated nodules are noted, as well as red spots on her anterior lower extremities that are distal to her knees. She states that she cannot sleep with a blanket on her bed due to the discomfort it causes when the blanket rubs against her legs. Dx?
Erythema nodosum
A 56-year-old woman has had multiple skin issues over the years. She has been on long-term treatment with methotrexate for psoriasis vulgaris, with occasional topical steroid application. She also has increased sensitivity to sunlight. She has a questionable lesion pictured below. The lesion is shown in the image. (Hyperpigmentation, irregularity, asymmetry) Next best step in management?
Excisional bx (melanoma)
A 4-year-old girl is brought by her mother to the ED for swelling and redness of the left elbow. The mother tells you that the child fell onto the elbow 4 days prior and had sustained a small abrasion. The child scratched and picked at the wound for 2 days and subsequently developed redness around the site and purulent drainage from the wound. Yesterday the elbow became quite swollen and the child had a fever of 103° F. The mother states that the area of redness has increased rapidly over the past 24 hours. A photograph of the involved area is shown. (elbow cellulitis) Organism?
Group A Streptococcus
A 27-year-old female comes to your clinic complaining about painful, itchy blisters on her private parts. She is G0P0, has a regular monthly cycle (29/5), menarche at 13, and has had a steady partner for two years. She does not use any method of birth control, including condoms. She states that both, her partner and she are monogamous and he does not have any symptoms. Two days earlier, she had been feeling sick. She was taking OTC aspirin, but still has an elevated temperature of 37.5° C. Upon examination you palpate enlarged lymph nodes in the inguinal area and see multiple vesicles on her labia and perineum, some ruptured, and some crusted over. There is no vaginal discharge and the rest of the pelvic exam is unremarkable. Which test will confirm your clinical diagnosis?
HSV culture
A 40-year-old man presents with a 3-day history of right-sided chest pain. The patient reports that the pain is gradually increasing in intensity, burning in character, and like a band across his mid-chest and mid-back on the right side. Today, he has noticed a light rash in this area. He has no fever, but he is experiencing fatigue and malaise. His past medical history includes GERD (for which he is on lansoprazole daily), asthma (for which he uses an albuterol inhaler daily), and knee arthritis (for which he uses over-the-counter low-dose naproxen prn). Family history is noncontributory. On examination, he is afebrile with a BP of 128/80 mm Hg and a pulse of 70 bpm. Oral exam is unremarkable. Lungs are clear, and the abdomen is benign. On the right side of his chest, there are small vesicles with surrounding erythema in the mid-region. The skin is excruciatingly tender in a dermatomal fashion along the affected area. Dx?
Herpes zoster infection
A 4-year-old boy presents with skin eruptions, fever, and diarrhea. Skin eruptions developed 1 week ago; they developed after exposure to multiple mosquito bites that left weepy, crusted areas. Over the past 2 days, the boy has become quiet, sleepy, and febrile; he has had a few loose stools. His past medical history is non-contributory, and his immunizations are up to date. On examination, you find a child in a mild distress; his temperature is 39 C. Heart rate is 100/min, and respirations are 22/min. On the skin of the arms and trunk, you notice multiple excoriations; there are a few fragile thin-roofed, flaccid, and transparent bullae, with a clear, yellow fluid that turns cloudy and dark yellow. Several bullae are ruptured, leaving behind rims of scales around erythematous moist bases, but no crusts. You also notice patches of skin of brown-lacquered appearance, with collarettes of scale and peripheral tube-like rims. For this condition, what is the primary mechanism of action of the antibiotic that represents the best treatment option?
Inhibition of peptidoglycans synthesis
An 18-year-old college student presents with a bright red rash on her left cheek area that has worsened since yesterday when it first appeared. It is now becoming more tender and she developed a temperature elevation of 100.2°F taken at home. She denies any new soaps or facial creams, and wears occasional make-up. She denies any ill contacts. Her current temperature is 101.2 and she feels ill. Your most likely diagnosis is erysipelas. She denies any medication allergies. The most important next step in the management of this patient is
Intravenous penicillin G for 48 hours, then Penicillin VK 250 mg 4 times daily for 7 days Erysipelas is a cellulitis caused by beta-hemolytic streptococci and causes a painful, bright red area that is typically seen on the cheek often near the angle of the nose. If this disease is not treated promptly, it can become systemically toxic and may result in death, especially in the very young and very old. In most cases, IV administration of an antibiotic active against beta-hemolytic streptococci and staphylococcus for the first 48 hours is indicated followed by oral administration of similar drug for 1 week. If it is a very mild case, IV antibiotics are not always indicated, but in this case, a fever of 101.2°F would constitute a more severe infection warranting IV antibiotics first.
Refer to the image. The 26-year-old male seen in the image is HIV positive with a CD4 count less than 200. While he was in the hospital for the treatment of his miliary Tb, he developed smooth, skin-colored, umbilicated papules on his face. The lesions are asymptomatic but spreading gradually to the other parts of the body and causing cosmetic problems to the patient. What is the name of this skin infection?
Molluscum contagiosum
A 4-year-old boy presents with skin eruptions, fever, and diarrhea. Skin eruptions developed 1 week ago; he was in the Caribbean with his parents, and he was exposed to multiple mosquito bites. It was at the sites of mosquito bites that his parents initially noticed weepy, honey-colored crusted areas; the boy notes itching. Over the past 2 days, he has become quiet, sleepy, and febrile; he has had a few loose stools. His past medical history is non-contributory, and his immunizations are up to date. On examination, you find a child in a mild distress; his temperature is 39°C. Heart rate is 100/min, and respirations are 22/min. On the skin of the arms and trunk, you notice multiple excoriations, vesicles, and 'collarette' of scale surrounding the blister roof at the periphery of ruptured lesions; also seen are bullae, with erythematous bases between and adjacent to the lesions. What topical medication should you prescribe in addition to oral medications?
Mupirocin Your patient most probably has bullous impetigo; a pathognomonic finding of this condition is a "collarette" of scale surrounding the blister roof at the periphery of ruptured lesions. It is caused by Staphylococcus aureus, producing exfoliative toxins that cause epidermo-dermal separation, which is macroscopically presented as vesicles. Vesicles rapidly enlarge and form the bullae. Itching, lymphadenopathy, fever, and diarrhea may accompany skin lesions. Antibiotic creams are the preferred topical treatment, and mupirocin is considered the most effective. Neosporin, fusidic acid, and chloramphenicol are other options.
A 23-year-old Caucasian woman complains of severe itching and burning pain in her earlobes. She has a 3-day history of wearing new ear studs. On examination, there is redness and inflammation of both ear lobules with a few blisters. You suspect allergic contact dermatitis to 1 of the metals in the ear studs. Most likely metal?
Nickel
A 63-year-old male Caucasian farmer presents to your office for a routine physical exam. His past medical history is positive for hypertension and he has been well maintained on a regimen of a beta-blocker for many years. He continues to feel well and is very active on his farm, working outside for hours each day. Examination of his skin reveals a 4-mm papule on the forehead; it is pearly white and rather flat. There are small telangiectatic vessels seen in the lesion, with a small amount of scale in the center. The patient believes the lesion has been there for a few months, but he is not sure. Dx?
Nodular basal cell carcinoma
An 18-year-old man presents with multiple painful vesicles on an erythematous base on the right side of his lower lip. He experienced similar symptoms a month before this occurrence with an associated sore throat. He has an oral temperature of 101°F and positive tender cervical lymphadenopathy. What is the most appropriate clinical intervention at this time?
Oral valacyclovir
A 33-year-old Caucasian man presents with redness, itching, and burning on the back of his hands. He gives a history of clearing 'weeds' on his farm yesterday. You ask him to describe the weeds, and he states that they had a cluster of 3 leaves. There are several tiny blisters with a linear distribution on both his hands. Dx?
Poison ivy dermatitis
A 20-year-old African-American woman presents with itchy rashes on her hands. She reports that they have been persistent for the past 2 years. On examination, deep-seated vesicles with scaling on her palms are noted bilaterally. Dx?
Pompholyx (type of eczema, usually restricted to hands)
A 14-year-old African American boy presents to your clinic with a several-week-long history of the appearance of spots on his face; they produce pus when he squeezes them. Over the past 1 week, he has also noticed similar spots on his back. He recently began smoking cigarettes. His 17-year-old brother also has similar spots on his face. What is not a pathogenic factor associated with his condition?
Poor hygiene
What finding would most suggest a diagnosis of cellulitis?
Poorly differentiated diffuse redness with warmth
A 35-year-old man presents with a skin eruption that has been developing slowly for several months. The lesions are symmetric, involve primarily the elbows, knees, and scalp, and appear as erythematous, sharply demarcated plaques covered by a silvery scale. Dx?
Psoriasis
A 35-year-old obese man presents with a 6-month history of itchy rash. He was referred to you by his primary care physician, who treated him for tinea cruris over a period of 4 months with limited success. A brief history reveals the patient is bipolar on lithium, does not smoke, and takes no other medications aside from the terbinafine (Lamisil) tablets prescribed by the primary physician. On physical examination, the rash is located primarily in the intertriginous areas of the groin, but it can also be seen in the axillary and sacral regions. The morphology is variable, but it is largely consistent with that of erythematous plaques. Scaling is widely observed, except for in the groin, where the plaques are moist and more confluent. The dermatologist does a KOH preparation of the scrapings and finds no hyphae. Dx?
Psoriasis
A 53-year-old Caucasian man presents due to a bleeding mole on his face. The mole is located on his left cheek; it has been present for the past several years, but in the last 3 months, it has started to spontaneously bleed. The patient denies any other moles with the same characteristics, and he just wants it taken care of, so it is not as bothersome. The patient denies weight loss, night sweats, or fevers; he has no recent changes in his appetite or sleeping issues. He is a farmer, and he owns over 100 acres that he plants and harvests yearly; he has done so for the 25 years. On physical examination, you find a 4 cm macule that has irregular borders; there are at least 3 different shades of color to it, and there is a small ulcer in the middle of it. Considering the most likely diagnosis for this patient, what diagnostic study is most crucial to confirm this pathology?
Punch biopsy
A 50-year-old woman has had a facial rash and a 10-year history of reddening of her face that comes and goes. On physical exam, you note erythema, telangiectasia, red papules, and tiny pustules on both cheeks. What is the most likely diagnosis?
Rosacea
A 16-year-old boy presents with a general complaint of itching of his hands and wrists. He says it started a few weeks after he went to play in a high school soccer tournament down south. On physical exam, you note numerous wavy, skin-colored ridges on his hands and wrists with excoriations. You also note the intertriginous areas of the hands are involved. Dx?
Scabies
A 23-year-old man presents with unbearable itching in his genital area. The itching increases in intensity at night. He admits to several recent sexual encounters with different people in the past month. Skin exam reveals multiple excoriated papules and burrows with surrounding inflammation. What is the most likely diagnosis?
Scabies
A 20-year-old Caucasian woman presents to the hospital with a 2-month history of itchiness of her scalp. On examination you note greasy yellowish scales on her scalp and eyebrows. Dx?
Seborrheic dermatitis
A 42-year-old man presents with a 3-month history of a persistent, slowly worsening rash. He changed soaps and shampoos without any effect, and he got some relief with OTC 0.5% topical hydrocortisone. He experienced the same symptoms a year ago from February to March, but it was not as severe as this time, and it resolved without treatment after 6 weeks. The rest of his past medical history is unremarkable, and he does not take any medications. On examination, you see diffuse, yellowish, greasy scaling of the scalp, the forehead, upper chest, and groin area, with scaling papules along the hairline, behind the ears, at the nasolabial folds, and in the external auditory canals. Dx?
Seborrheic dermatitis
An 8-month-old male infant presents with rashes over the scalp and eyebrows. Physical examination shows a dry, scaly, and crusting lesion over the scalp, eyebrows, and nape area. He is comfortable, so his mother presumed that it was not itchy at all. He has been breastfed up to the present, and he started solid food at about 5 months old. There are no other signs and symptoms noted. Bowel movement and urination are normal. Developmental milestones are consistent with age. What is the most likely diagnosis?
Seborrheic dermatitis
A 32-year-old man presents with symptoms of a skin rash. He has had the rash on his left arm for about a month and has tried only over-the-counter hydrocortisone cream without change. He denies previous skin lesions and states that this one is asymptomatic. The physician assistant (PA) who sees the patient immediately tells him that he has tinea corporis. How should the lesions be described in his office visit note?
Sharply defined annular papules with central clearing ("ringworm")
A 70-year-old man presents for a routine physical examination. He has been in a good state of health, but he is concerned about a growth on his right leg. He states that it has been present for about 1 year; it disappears once in a while, but then it returns, sometimes covered with white scales that then dropped off. On further questioning, he gives a history of spending countless hours at the beach body surfing as a youth; he rarely used sunscreen. On examination of the skin, you note a round pinkish spot measuring about 0.5 cm in diameter on the posterolateral aspect right leg. The lesion is raised; it feels dry and rough to touch. You suspect skin cancer, and you refer the patient to a dermatologist who decides to cauterize the lesion with liquid nitrogen. Within 3 weeks, the area becomes crusted, shrinks, and falls off. 2 weeks thereafter, the spot returned, and after a month, it develops into an open sore that will not heal. Dx?
Squamous cell carcinoma (SCC)
A 40-year-old woman presents with a 6-month history of itchy lesions on her left ankle. On examination, her left leg is erythematous with scaly patches and an ulcer over the medial malleolus; she also has bilateral varicose veins. Dx?
Stasis dermatitis
A 17-year-old girl presents with a painful, swollen, red left forearm. Symptoms began about 2 days prior to presentation; they followed a bug bite and initially presented as a small red area. She does not recall any other injuries to the arm. She denies fever, chill, nausea, and vomiting, but she states that she has had increased pain and swelling over the last day or so. She has no significant past medical history, and she had been well until this recent illness. Physical examination reveals a well-developed, well-nourished patient in mild distress. Her exam is significant for an erythematous, warm, shiny plaque area measuring approximately 5 cm in diameter with a well-defined border on her left forearm. Vital signs are as follows: blood pressure 110/72 mm Hg, pulse 78 beats per minute, temperature 99.6°F, and respiratory rate 14 breaths/min. What is the most common cause of this condition in the United States?
Streptococcus pyogenes (erysipelas)
A 24-year-old woman presents with a rash. She has never had a rash like it prior to presentation. You ask about symptoms, and the only thing she states is that it mildly itches. On physical examination, you note scattered multiple lesions with marked vesicles, pustules, sharply marginated plaques with central clearing, and crusting at the margins that produces annular configurations; the rash appears only on the arms, neck, and trunk. What detail of the patient's history, if elicited, may denote the etiologic cause of this disorder?
The patient works with animals (tinea corporis)
A 13-year-old boy presents for the treatment of acne vulgaris that did not respond to antibiotic therapy. On physical examination, the patient's torso and shoulders showed several ill-defined annular lesions, with fine scale and decreased pigmentation. Samples of the skin were obtained, and a potassium hydroxide preparation was positive for hyphae. A diagnosis of tinea versicolor is considered. True statement about the condition?
There is a high recurrence rate.
A 10-year-old boy presents with a 1-week history of a rash on his scalp. His mother states that the boy has been scratching his head often, and she notes that there are areas where his hair appears to have fallen out. She attempted to treat it with over-the-counter preparations, but his condition has not improved. The boy is active and otherwise healthy. The rash appears as erythematous, circular, scaly patches. There are areas where the hairs have become brittle and broken off. A scraping of one of the patches is placed in potassium hydroxide solution and shows hyphae. Dx?
Tinea capitis
An 11-year-old boy is seen for a patch of itchy skin on his forehead. He has just returned from a vacation in Florida where he visited with friends who have several pets. His mother states that he has not been sick lately. The lesion appeared 1 week ago overnight and has been growing slowly since then. The lesion is the size of a half dollar, annular with sharp margins, and lightly scaly. KOH examination of the scale shows hyphae. Refer to the image. (annular) Dx?
Tinea faciei
A 20-year-old Caucasian college student comes in with a complaint of hypopigmented patches which appeared gradually during the summer. He reports no history of unprotected sex. Scaly patches are present, but no pruritus. On examination, he has hypopigmented patches over the face and chest, but no vesicles or pustules. Dx?
Tinea versicolor
A 62-year-old man who is well known to you presents due to an itchy rash. The patient's medical history includes Parkinson's disease for the past decade. The patient believed the rash was just a mosquito bite at first due to the fact that it stayed small and confined to one space. This area has spread and now has characteristics of hives and intense itching. On examination, you note three bullae that are 1 to 3 cm in size, tense, and appear on an erythematous base. The bullae are noted to be located on the right trunk in a region that measures 5 centimeters in diameter. This patient states he has come to you for treatment of this issue before, around 5 years ago. What would be the best course of action to alleviate the effects of this patient's diagnosis?
Topical CCS (bullous pemphigoid)
A 32-year-old woman is brought to the emergency room with sudden onset of fever, headache, sore throat, profuse watery diarrhea, vomiting, and lethargy; symptoms started in the morning. On physical examination, she is slightly confused; her temperature is 39°C (103°F), her blood pressure is 100/50 mmHg, and she has diffuse sunburn like an erythematous rash. When the emergency doctor is trying to find out if she is pregnant, she mentions that her period started 2 days ago. Dx?
Toxic shock syndrome
A 7-month-old child presents to the emergency room exhibiting toxic epidermal necrolysis and large, flaccid bullae that are forming and rupturing under the epidermis, causing desquamation in the diaper area. This spectrum of disease describes a condition usually caused by which one of the following?
Toxin producing Staphylococcus aureus.
A 28-year-old woman presents with dark spots on her nose. She states that she was diagnosed with acne vulgaris, but the treatment was not successful. On examination, small black papules less than 1 mm are found on her nose, but they are not surrounded by inflammation. On removal with forceps, the patient does not feel any discomfort. Examination of the lesion with hand lens shows vellus hairs in the keratinous plug. Dx?
Trichostasis spinulosa
An 18-month-old infant presents with a 1-day history of fever that is currently 101°F rectally. You symptomatically treat the patient and ask the mother to return if the condition worsens. 2 days later, the mother returns because the infant has developed small red spots that became bumps and are now blisters. The mother also noted the infant was scratching the lesions. The majority of these lesions are on the thorax. Each vesicle resides on its own erythematous base. Dx?
Varicella
A 71-year-old man with a history of prostate cancer and unstable angina is admitted to a community hospital for facial cellulitis. Examination shows an indurated erythematous rash that extends across the face and zygomatic arch to the lip. In the oral cavity, vesicular lesions are present on the hard palate. Laboratory results are within normal ranges. The patient describes the lesions as very painful. A Tzanck smear of the vesicle showed multinucleated syncytial giant cells and intranuclear inclusion bodies. What is the most likely causative agent?
Varicella-zoster virus
