Joe Monroe, PA-C

For years, a 39-year-old man had an eruption on his hand, which seemed to becontrolled with topical corticosteroids. The patient was a rancher.

The continuous use of a corticosteroid cream briefly relieved the pruritus of anannular, papulosquamous eruption on the left anterior thigh of a 50-year-oldwoman. The lesion was present for 6 months and grew larger with applicationof the topical corticosteroid.

A palpable papulosquamous, arciform chronic eruptionhad been present in a 70-year-old man for many years.The asymptomatic rash was in a “mantle” distribution-across the upper shoulders, neck, and back.

For several months, a 19-year-old manhad asymptomatic hyperpigmentedand hypopigmented macules on theright volar forearm. Recent applicationsof topical corticosteroids madethe lesions more noticeable.

A 70-year-old man first noticed thisskin condition when he returned fromthe South Pacific at the end of WorldWar II. Over the years, the rash hasitched only occasionally; however,during a recent spate of hot weather,the eruption became highly pruritic.Applications of an over-the-counter1% hydrocortisone ointment exacerbatedthe condition

An eruption on the face of a 49-year-old woman had been misdiagnosed as astaphylococcal infection; the rash failed to respond to oral and topical antibiotics.A mid-potency topical corticosteroid also had been tried, but the eruptionworsened.

The parents of a 3-year-old girl sought evaluation of their daughter’s hair loss.During the past several months, a large patch of alopecia with scaling had developed.The differential diagnosis included seborrhea, trichotillomania, andtinea capitis.

Several times a year a rash erupts on the chest, axillae, and neck of a 41-year-old woman. Her father and siblings have a similar history. A biopsy of the affected skin confirmed the suspected diagnosis of benign familial pemphigus, which is also called Hailey-Hailey disease.

A 38-year-old man was concerned that the small lesions on his lips were flatwarts. A biopsy identified Fordyce, or sebaceous, glands of the lips.

The soft “bubble” on the mucosal surface of a 42-year-oldman’s lower lip had developed, disappeared for 3 months,and returned. The lesion caused no pain or discomfort.

Bald patches were noted on the head of a 40-year-old woman with longstanding mental illness. She claimed, “I have to pull out my hair, so my scalp won’t hurt.” The patient began pulling out her hair when she stopped taking her psychotropic medications 6 years earlier.

A 63-year-old woman presents withdiffuse hyperkeratosis of the solesand palms. She also has onycholysis-separation of the nail plate fromthe nail bed-and salmon-coloredplaques behind her ears. Biopsy ofone of the plaques confirms the suspecteddiagnosis of psoriasis.

A 46-year-old man complains that his"jock itch" failed to respond to antifungalcreams. The patient has hadpsoriasis on his elbows and knees formany years.

4A:Small, slightly pruritic, salmonpink papules with thick white scalehave arisen over the past 5 days onthe trunk and arms of a 24-year-oldman. The patient has a history ofvery mild psoriasis vulgaris of the elbows,knees, and scalp; he deniesstreptococcal pharyngitis or other recentinfections. Guttate psoriasis isdiagnosed.

Focal, painless discoloration of theleft thumbnail (A) developed severalyears earlier in this 46-year-old man.Oral antifungal therapy had no effecton the lesion.