Adult Immunization

Anaphylaxis

Food Allergies

Seasonal Allergies

Allergy

Atrial Fibrillation

Cardiovascular Disease

Heart Failure

Hypertension

Lipid disorders

Cardiology

Clinical Technology

Atopic Dermatitis

Psoriasis

Rosacea

Dermatology

Adrenal Disorders

Diabetes

Thyroid Disorders 

Endocrinology 

C Difficile Infection

Celiac disease

GERD

Inflammatory Bowel Disease

Irritable Bowel Syndrome 

Gastroenterology

Hepatitis

MASLD/MASH

Hepatology

Coronavirus

HIV AIDS

Hepatitis C

Influenza

Pneumonia

Sexually transmitted infections

Infectious Disease

Chronic Kidney Disease

Nephrology

Alzheimer Disease/Dementia

Cerebrovascular Diseases

Epilepsy

Headache

Mental Health

Migraine

Nervous System Diseases

Parkinson Disease

Sleep Disorders

Stroke

Neurology

Obesity Medicine

Fibromyalgia

Pain Management

Pediatric Immunization

Pediatrics

ADHD

Anxiety

Depression

Eating Disorders

PTSD

Panic Disorder  

Psychosis

Substance-related Disorders

Psychiatry 

Asthma

COPD

Cystic Fibrosis

Interstitial lung disease

Pulmonary hypertension

Respiratory Diseases

Pulmonology

Gout

Lupus

Osteoarthritis

Psoriatic arthritis

Rheumatoid Arthritis

Rheumatology

Breast Cancer

Cervical Cancer

Colorectal Cancer

Lung Cancer

Melanoma

Prostate Cancer

Renal Cancer

Skin cancer

Screening

Menopause

Osteoporosis

Pregnancy and Birth

Women's Health

News

All News

Editorial Podcasts

Practice Management

Video Interviews

Media

Around the Practice

Between the Lines

ConsultantLive

Frontline Insights

Institutional Insights

Primary View

Provider Toolkits

Screening Series

Conferences

Conference Coverage

Conference Listing

Product Theater Recaps

Resources

Interactive Posters

Product Profile

Publications

Subscribe

CE/CME

Patient Care Online offers clinical news and resources for primary care clinicians, focusing on disease states, guidelines, and trends to improve care.

About Us

Advertise

Contact Us

Editorial Board

Terms and Conditions

Privacy

Do Not Sell My Information

Patient Care Online – Primary Care News and Clinical Resources

Facebook

LinkedIn

Clinical Focus

Allergy & Immunology

Endocrinology

Men’s Health

Psychiatry

Women’s Health

Business Focus

Billing and Collections

Career Planning

Coding and Documentation

Concierge Medicine

Cybersecurity

EHRs

Investing

Patient Relations

Personal Finance

Remote Patient Monitoring

Staffing

Technology

Telehealth

Value-based Care

Spotlight

VMS and Menopause

Atopic Dermatitis Provider Toolkit

Adult Immunization Provider Toolkit

Dermatology Hot Topics

1rem

Authors


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Pain was minimal and associated with extension and flexion.

Medial collateral and lateral collateral ligament injury

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Your dx?

Swelling Over Left Anterior Knee

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.

Clinical Topics

White Knuckles

This image of the dorsum of the tongue of a 42-year-old African American woman shows parallel linear black coatings.

After a “swig” of  Kaopectate, this patient noticed tongue discoloration. Is this coincidental, or is there a clinical connection? 

Black Coating on a Woman’s Tongue

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 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 

Leo Robert

Articles

Latest Updated Articles