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Cutaneous Conundrums, Dermatologic Disguises

Cutaneous Conundrums, Dermatologic Disguises

Case 1:
A nonhealing ulcer recently developed
in a painful facial rash that had
worsened over several months. The
44-year-old patient is a heavy drinker
with a history of elevated liver function
levels. She has had numerous
unprotected sexual contacts over the

An oral cephalosporin has had
no effect on the facial eruption.
The patient denies the use of other

Which of the conditions in the
differential is the likely cause?

A. Bacterial infection secondary to

B. Squamous cell carcinoma.

C. Bacterial infection secondary
to rosacea.

D. Deep fungal infection.

E. Pyoderma gangrenosum.

F. Factitial disorder.

Which course of action do you

G. Perform a bacterial culture.

H. Perform a fungal culture.

I. Determine the patient's HIV

J. Obtain a hepatitis panel.

K. Perform a skin biopsy.

Case 2:
Neither oral terbinafine nor oral itraconazole resolved the white patch on a
62-year-old woman's fingernail. The condition, which first arose 3 months
ago, causes slight, intermittent tenderness. The patient is otherwise healthy
and takes no medications.

What is the likely cause of this condition?

A. Thyroid disease.

B. Diabetes mellitus.

C. Onychomycosis.

D. Candida onycholysis.

E. Psoriasis.

To confirm your suspected diagnosis, you . . .

F. Perform thyroid function tests.

G. Obtain a serum glucose level.

H. Perform a potassium hydroxide evaluation.

I. Perform a fungal culture.

J. Perform a bacterial culture.


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