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Consultant Vol 43 No 7

A 29-year-old man presents with right ankle pain
caused by a basketball injury he sustained 1 day earlier.
He fell after he had jumped up and landed on another
player’s foot. The patient’s foot was “turned in” during the
fall; this position indicates an inversion injury. He says he
has injured his ankle before but never this severely. The
rest of the medical history is noncontributory.

A healthy 16-year-old girl was bothered by a patch of white hair on her forehead; she also had a few white plaques on her abdomen, which had been present since birth. Her maternal great grandmother and maternal grandfather, as well as her mother, had a similar pattern of white hair.

Several asymptomatic, erythematous papules and plaques had appeared on the hands of an otherwise healthy 11- year-old girl. The personal and family medical histories were noncontributory.

A 60-year-old man with a long history
of psoriasis vulgaris required a systemic
corticosteroid for a severe exacerbation
of asthma. Soon after theErythrodermic or Pustular Psoriasis
corticosteroid was discontinued, generalized
erythema and scaling of the
skin developed.

A 35-year-old man presents with extensive
plaques over much of the
trunk and extremities. This severe
flare of psoriasis developed after a
stressful emotional experience.

Focal, painless discoloration of the
left thumbnail (A) developed several
years earlier in this 46-year-old man.
Oral antifungal therapy had no effect
on the lesion.

4A:Small, slightly pruritic, salmon
pink papules with thick white scale
have arisen over the past 5 days on
the trunk and arms of a 24-year-old
man. The patient has a history of
very mild psoriasis vulgaris of the elbows,
knees, and scalp; he denies
streptococcal pharyngitis or other recent
infections. Guttate psoriasis is

A 45-year-old woman presents with multiple injuries she sustained during a skiing
accident. She has fractures of her right arm and 3 ribs, as well as numerous
contusions. An abdominal CT scan shows no hemorrhage or other traumarelated
findings; however, a 6.7-cm left adrenal mass is detected.

A 72-year-old man presents with skin
lesions and nail abnormalities. Erythematous,
sharply defined, demarcated
papules and rounded plaques
covered by silvery micaceous scale
are noted on the elbows, knees, and
scalp. Involved areas appear to be bilaterally
symmetric. Localized psoriasis
vulgaris is diagnosed.

A 46-year-old man complains that his
"jock itch" failed to respond to antifungal
creams. The patient has had
psoriasis on his elbows and knees for
many years.

A 30-year-old man presents with scaling
and erythema of the scalp that extends
past the anterior hairline. The
patient has a family history of psoriasis.
For the past 5 years, he has experienced
wintertime flares of the disease
that affect his scalp and the extensor
surfaces of the extremities.

A middle-aged man with
"jock itch" that has failed to
respond to antifungal creams.
An older woman who has diffuse
hyperkeratosis of predominantly
weight-bearing surfaces.
A young man with mildly
pruritic, small, salmon pink
papules and thick white scale
on his trunk and arms.

A 63-year-old woman presents with
diffuse hyperkeratosis of the soles
and palms. She also has onycholysis-
separation of the nail plate from
the nail bed-and salmon-colored
plaques behind her ears. Biopsy of
one of the plaques confirms the suspected
diagnosis of psoriasis.

Progressive abdominal distention, nausea, constipation, and mild abdominal pain developed in an 82-year-old woman 5 days after she underwent surgical repair of a left hip fracture. Her medical history was significant for Parkinson disease, type 2 diabetes mellitus, and hypertension.

An ulcerated lesion that measured approximately 2 cm in diameter had developed on an 80-year-old woman's scalp. The lesion featured a dark eschar that covered a slightly elevated, erythematous border. According to the patient's husband, a different lesion had been at the site 2 weeks earlier. He described the original as a "ball" that ulcerated, had no drainage, and formed a scab.

A 77-year-old African American man with type 2 diabetes mellitus and coronary artery disease presented to the emergency department with acute scrotal swelling and pain. His testicles were erythematous with focal areas of necrosis and associated tissue destruction. Similar skin changes were apparent in the lower abdominal and inguinal regions.


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