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Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.

Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Disseminated Gonococcal Infection

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? 

Clinical Topics

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

Radiographic findings may help differentiate chronic gout from other inflammatory arthritides. A radiopaque tophus, a typical finding, is seen over and adjacent to the fifth metatarsophalangeal (MTP) joint (arrowhead).

“Rat bite” or “punched out” erosions

Can you spot the x-ray evidence to detect the suspected diagnosis?

Gout Clues

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?

In our 2024 PatientPoint Patient Confidence Index, we surveyed 2,000 Americans to understand their views on doctor visits and the healthcare industry. This report reveals insights to help providers better understand the patient experience and engage in meaningful patient conversations.

Key insights include:

81% of patients trust their doctor, with 33% noting increased trust over the past year.

66% feel heard and respected by their doctor.

52% decrease in patients feeling confused after appointments in the last two years.

Download the report to get access to this year’s insights.

Complete the form to download the report.

In our 2024 PatientPoint Patient Confidence Index, we surveyed 2,000 Americans to understand their views on doctor visits and the healthcare industry. This report reveals insights to help providers better understand the patient experience and engage in meaningful patient conversations. 

Key insights include: 

81% of patients trust their doctor, with 33% noting increased trust over the past year. 

66% feel heard and respected by their doctor. 

20% decrease in patients feeling confused after appointments in the last two years. 

Download the report to get access to this year’s insights.  

2024 PatientPoint Patient Confidence Index

A 3-year-old boy is seen for unilateral swelling on the left side of the face, in front of and behind the left ear. Findings on examination of ears, oral cavity, and teeth are normal. He is afebrile (temp, 37°C [98.6°F]), cooperative, and in no distress. He is otherwise healthy. Past medical history includes 1 MMR vaccination.

The child is bright and alert and has no fever. The swelling is on the left side of the face only. Find other clues to a diagnosis in the accompanying video.  

3-Year-Old Boy With Unilateral Facial Swelling 

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?

Lisa Travis, MD

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