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A 60-year-old Caucasian man with a history of invasive squamous cell carcinoma of the lung presents with the lesions shown. Metastases to the skin can be a clinical finding in many malignancies.

Metastatic Carcinoma

A 13-year-old girl with known eczema presents with a vesicular rash on her palms that appeared after swimming in the ocean. Skin is tender; vesicles ooze clear liquid. Treated with triamcinolone w/o effect. Watch real-time examination on video.

A. Acute palmoplantar eczema (dyshidrotic eczema)

VIDEO: The child's hands are chronically dry but the skin has recently begun to crack; vesicular rash appeared after an ocean swim. Dx?

Clinical Topics

A 13-year-old Girl with a Vesicular Rash on Palms 

A 64-year-old woman with a history of basal cell carcinoma presents to the dermatologist for skin cancer surveillance. She is incidentally noted to have bruising on her upper eyelids (above). On questioning, she reports experiencing recurrent intermittent eyelid bruising for several years. She denies a history of trauma to her face, pain, or other associated symptoms.

Her medical history is significant for hyperlipidemia, hepatitis C (diagnosed >30 years earlier), osteoporosis, celiac disease, and idiopathic proteinuria for several years. Her surgical history includes appendectomy and carpal tunnel repair.

Pertinent family history includes her mother dying of multiple myeloma and her father of complications of diabetes.

Review of systems is significant for vague symptoms of gastrointestinal discomfort. On more directed questioning, she reports the eyelid purpura is temporally related to the Valsalva maneuver/ strained bowel movements. Her medications include atorvastatin, risedronate sodium, a daily multivitamin, calcium, vitamin D, and aspirin.

Her examination reveals no bruising elsewhere and no findings of interest on skin or mucous membranes.

B. Allergic contact dermatitis, purpuric type

Eyelid bruising was observed on a 64-year-old woman during routine skin cancer follow-up. She denied trauma or pain. What does this look like to you? 

Image IQ: Recurrent Eyelid Purpura 

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

A panel of experts on type 1 diabetes (T1D) describe the prevalence and burden of the disease, highlighting the emotional and socio-economic burden extending beyond medical expenses.

Navigating T1D: Mitigating Burden and Monitoring Disease Progression

The following is a summary of the video transcript and has been edited for length and clarity. 

Jennifer D. Goldman, PharmD, RPh, CDCES, BC-ADM: 

Dr Burton, would you talk about the prevalence of type 1 diabetes and also about the myth around who is at risk for the disease?



 What's interesting is that we are definitely seeing increased rates of type 1 diabetes diagnoses. And there are a number of different causes including COVID-19 and other viruses. But while most people tend to think of type 1 diabetes as a disease diagnosed in children, over the past few years we’ve seen that the majority of new cases are in adults over the age of 20 years. And that’s the myth, that it's always kids and that's what we need to watch. It's so important that we consider adults and young adults, adults when we think about diabetes and screening.

How does family history affect the risk of type 1 diabetes?

 A family history of type 1 diabetes increases a first-degree relative’s risk for the condition by 15-fold, so this is something that we need to speak to our patients about. We don’t take care of all of the children in a family or the adults; we may treat one person in a family of 5. We need to make the person we treat or the caregiver aware of the family risk and that there is screening available.

What about the socioeconomic and emotional burdens of type 1 diabetes?

: Both burdens are huge. Financially, there are the direct costs of supplies, insulin, continuous glucose monitoring (CGM) supplies, pump supplies, doctor's visits including other specialists, therapists. There are potential hospitalizations. The emotional aspect is sometimes even bigger. For a kid, there are the social implications; you're a little bit different than your peers, things might look a little bit different for you at school or at parties or at sports. You might have to pay attention to things that nobody else has to pay attention to, carb counting, blood sugar monitoring. And then the strain on families is pretty incredible. We see a lot of difficulties in marriages. Maybe one parent takes the burden of caring for the affected child and resentment builds. All around the impact of type 1 diabetes on a family can be huge.

Goldman: Are you doing referrals to other specialists?

I think it's always important to refer to a therapist or a counselor. If there are support group options, that's helpful. I think sometimes people just want to be with people like them. And for kids it's great because there's so many diabetes camp options where they can go and they could feel like everything is normal. So just getting around others that are in the same boat is super helpful.

This afebrile baby presents with a target-shaped, centripetal rash. He has been taking amoxicillin for 5 days for an ear infection.

1-Year-Old With "Bullseye" Rash

Alexandra Flamm, MD

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