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Foreign-Body Aspiration in a Middle-Aged Woman

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

Clinical Topics

What's This "Red Spot"?

This 13-year-old boy presents with hyperpigmented skin on his neck. He is 66.75 inches and weighs 232 pounds.

This 13-year-old boy presents with hyperpigmented skin on his neck. He is 66.75 inches and weighs 232 pounds. Your suspicion?

13-year-old With Hyperpigmented Rash

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 

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 American College of Lifestyle Medicine (ACLM) has released a clinical practice guideline that, for the first time, places lifestyle modification at the center of care for adults with 

,¹ the guideline offers clinicians a structured, evidence-based framework for integrating 

t into routine diabetes management. Unlike prior guidelines that acknowledge lifestyle’s importance but often lack practical direction, this document delivers actionable strategies for implementing and sustaining behavioral change, ACLM stated.

The audience for the guideline is "any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM)," the authors wrote.

The 14 recommendations, referred to as "key action statements," support clinicians in promoting lifestyle interventions as first-line management for prediabetes and type 2 diabetes, with an emphasis on the 6 core pillars of lifestyle medicine.

The guideline topline slide show above introduces primary care clinicians to the first codified approach to applied lifestyle change in diabetes care with an at-a-glance summary of the 14 recommendations.  

A substantial body of evidence supports the greater efficacy of lifestyle interventions over metformin for preventing progression of prediabetes to T2D.

 A 2022 meta-analysis reported that the effects of the interventions on the risk of impaired glucose tolerance or prediabetes advancing to T2D was "significantly correlated with multiple lifestyle changes," with study participants reaching the greatest number of targets achieving more pronounced effects.

"Although there are nearly 1,000 guiding documents for diabetes in the medical literature, and more than 350 pages of standards from the American Diabetes Association, they may not offer details and practice advice on lifestyle change," Richard M. Rosenfeld, MD, MPH, MBA, lead guideline author and ACLM director of guidelines and quality wrote.

. Rosenfeld RM, Grega ML, Karlsen MC, et al. Lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: a clinical practice guideline from the American College of Lifestyle Medicine. 

 First clinical practice guideline on lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults is published. News release. American College of Lifestyle Medicine. June 10, 2025. Accessed June 11, 2025. https://prnmedia.prnewswire.com/news-releases/first-clinical-practice-guideline-on-lifestyle-interventions-for-treatment-and-remission-of-type-2-diabetes-and-prediabetes-in-adults-is-published-302477850.html
3. Knowler W, Barrett-Connor E, Fowler S, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. 

2002;346:393-403. doi:10.1056/ NEJMoa012512 
4. Jiang Q, Li JT, Sun P, Wang LL, Sun LZ, Pang SG. Effects of lifestyle interventions on glucose regulation and diabetes risk in adults with impaired glucose tolerance or prediabetes: a meta-analysis. 

 2022;66(2):157-167. doi:10.20945/2359-3997000000441 
5. Rosenfeld RM. New clinical practice guideline puts lifestyle interventions at forefront of diabetes care. Lifestylemedicine.org. June 10, 2025. Accessed June 11, 2025. https://lifestylemedicine.org/articles/lifestyle-medicine-and-the-path-to-type-2-diabetes-remission/

These 14 recommendations from the American College of Lifestyle Medicine comprise the core of the first-ever guideline centered on lifestyle change as a first-line intervention.

Guideline Topline: 14 Key Lifestyle Interventions to Treat, Prevent Type 2 Diabetes

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. Several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. He had recently run through a field of tall grass but denied any other exposure history. Your Dx?

What Cause of This Itchy Rash?

Anup Singh, MD

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