Sunita Puri, MD

A 60-year-old man presented with redness, swelling, and pain on his right lower leg of 3 day's duration. He recalled being scratched by underbrush while hiking in the woods a few days earlier; the patient denied other recent trauma or insect bites.

During the last 3 months, scars had developed on the sternal area of a 25-year-old black woman. She recalls having punctured an acne pustule at the site just before the scar began to develop.

The parents of a 6-year-old boy with a generalized rash sought medical care for the child. The outbreak began 2 years earlier on the boy's abdomen and spread over the entire body; oral antihistamines had been prescribed for the itching. The patient had no history of allergy, insect bite, fever, or GI symptoms. His vital signs were normal.

A 35-year-old dental assistant sought treatment of an itchy, painful rash on her hand that had erupted 5 days earlier.

Disturbed by a pruritic rash of 5 days' duration on his chest, neck, and back, a 35-year-old man sought medical advice. The patient had no other symptoms.

A pruritic rash developed on the feet of a 40-year-old woman 2 days after she had worn a new pair of shoes for a few hours. The erythematous, papular, scaly eruption was more prominent on the right foot.

The upper and lower eyelids of a 6-year-old girl were stuck together after she accidentally splashed superglue in her left eye. The patient did not complain of pain; the eyeball was able to move freely under the lids.

The mother of this 5-month-old boy was concerned about the large birthmark in the infant's diaper area. This lesion is a bathing trunk congenital melanocytic nevus, writes Dr Sunita Puri of Decatur, Ala.

A 65-year-old man had a 10-year history of deformity of the hands, pain, and nodules on the fingers. His serum uric acid level was 9 mg/dL. The suspected diagnosis of chronic tophaceous gout was confirmed by the finding of birefringent monosodium urate needle-shaped crystals in the joint fluid and the patient's significant response to colchicine within 12 to 24 hours of the start of therapy.

A rash on both palms concerned a 35-year-old hairdresser, who said she always wears vinyl gloves while working. She recalled using a new hair coloring product on a client a few days earlier. Within 24 hours of applying the substance, the rash began to erupt; it worsened over the course of 2 days.

A 4-year-old girl is brought to the emergency department with a pruritic rash of 24 hours' duration. Her mother reports that the lesions developed after the child ate strawberries.

A 70-year-old man was concerned about these dark lesions that covered his back and legs.

This 60-year-old man has had rheumatoid arthritis (RA) for 40 years. Typical of progressive, long-standing disease is the deformity seen here in his hands and feet.

This 41-year-old woman rushed to the emergency department with a swollen, blistered tongue and difficultly in swallowing and speaking. Twenty minutes earlier she had eaten fish (for the first time in her life).

Two patients who presented for evaluation of unrelated maladies were noted to have true polydactyly. Both patients-a 32-year-old white man and a 35-year-old African American woman - had a duplicate left thumb. There were no other associated congenital abnormalities.

A healthy 16-year-old girl was bothered by a patch of white hair on her forehead; she also had a few white plaques on her abdomen, which had been present since birth. Her maternal great grandmother and maternal grandfather, as well as her mother, had a similar pattern of white hair.

Dry, pruritic, scaly skin was noted on a 65-year-old woman who came to the emergency department with bronchitis. She reported that her skin had had this texture all of her life.

The upper and lower eyelids of a 6-year-old girl were stuck together after she accidentally splashed superglue in her left eye. The patient did not complain of pain; the eyeball was able to move freely under the lids.

A pruritic rash developed on the feet of a 40-year-old woman 2 days after she had worn a new pair of shoes for a few hours. The erythematous, papular, scaly eruption was more prominent on the right foot.

The mother of this 5-month-old boy was concerned about the large birthmark in the infant's diaper area.