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Dermatology Hot Topics

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Authors

Research demonstrates that discussing test results face-to-face with patients during office visits is beneficial for patient and clinician, according to family physician Andrew Carroll, MD. 

It's High Time to Normalize Pre-Visit Lab Testing 

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

Clinical Topics

1-Year-Old With "Bullseye" Rash

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Rash Around the Mouth of a 5-year-old Child

A 4.5-cm annular lesion on this patient’s hand is similar to lesions found elsewhere on his body. The patient reports no symptoms. The skin is smooth and without scale. Visible is a ring of firm multiple papules. Treatment with a steroid ointment was unsuccessful.

The patient has similar lesions elsewhere on his body. Treatment with a topical steroid was unsuccessful. Can you ID?

A Ring of Firm Multiple Papules 

, and the link between HPV and cancer remains low across the United States, particularly in Midwestern and Southern states where HPV-associated cancers are most prevalent, according to a new cross-sectional study published in 

Researchers analyzed data from the Health Information National Trends Survey (HINTS) collected between 2017 and 2022, including 22 344 adults (mean age, 49 years; 51.1% women). Nationally, 34.3% of adults were unaware of HPV, and 37.6% were unaware of the HPV vaccine. Lack of awareness exceeded 40% in 7 states, primarily in the Midwest (Kansas, Nebraska, Illinois) and South (Mississippi, Arkansas, Alabama). More than 40% of respondents in 13 states were unaware of the HPV vaccine.

Among respondents who had heard of HPV, 70.8% were unaware that HPV causes oral cancers and 28.3% were unaware that HPV causes cervical cancer. In 45 states and Washington, DC, more than 60% of adults did not know about the link between HPV and oral cancer. In contrast, lack of awareness of the 

 was less common, ranging from 6.9% to 57.4% across states.

Authors noted that the results highlight an urgent gap in public knowledge given that HPV is associated with an estimated 48 000 cancer cases annually in the US, with nearly two-thirds occurring in the Midwest and South. Limited awareness in these regions coincides with lower 

 rates and rising incidence of HPV-related cancers, including oropharyngeal cancers.

The study’s limitations include its cross-sectional design, the ecological nature of state-level analyses, and small sample sizes for certain states. "Despite these limitations, this study offers valuable insights into public understanding of HPV and related topics across US states," investigators concluded. 

"Given the importance of timely HPV vaccination and the risk of early-life exposure, there is a critical need to enhance HPV awareness among adolescents, young adults, parents or caregivers, and pediatric and adult health care professionals," they added. 

Source: Garg A, Damgacioglu H, Graboyes EM, et al. State-Level Public Awareness of HPV, HPV Vaccine, and Association With Cancer. 

 Published online August 14, 2025. doi:10.1001/jamaoncol.2025.2638

New data show more than one-third of US adults are unaware of HPV or the HPV vaccine, with gaps greatest in the Midwest and South, where HPV-related cancers are most common.

Public Awareness of HPV and HPV Vaccine Remains Low, Especially in Midwest and South, Study Finds

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

Image IQ: Recurrent Eyelid Purpura 

No labs, no biopsies . . .  you can make this Doorway Diagnosis just by looking.

Pictured is the posterior right knee of a 69-year-old woman showing a rounded protuberance at the popliteal fossa.

No labs, no biopsies, no imaging -- only your seasoned clinical judgement is required to make a diagnosis in this case. 

Bulge Behind the Knee 

Andrew Carroll, MD

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