Adult Immunization

Anaphylaxis

Food Allergies

Seasonal Allergies

Allergy

Atrial Fibrillation

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

Parkinson Disease

Sleep Disorders

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

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

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 

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Clinical Topics

Scaly Plaque on the Nose

A 13-year-old girl with known eczema presents with a vesicular rash on her palms that appeared after swimming in the ocean. Skin is tender; vesicles ooze clear liquid. Treated with triamcinolone w/o effect. Watch real-time examination on video.

A. Acute palmoplantar eczema (dyshidrotic eczema)

VIDEO: The child's hands are chronically dry but the skin has recently begun to crack; vesicular rash appeared after an ocean swim. Dx?

A 13-year-old Girl with a Vesicular Rash on Palms 

According to the World Health Organization, 

saves approximately 4 to 5 million lives annually. The remarkable number is supported by estimates published in the 

 in 2024 that vaccination against 14 different diseases saved 154 million lives over the past 5 decades.

 than age 5 years and of that group 101 million were infants younger than 1 year.

 Beyond the prevention of death, authors of the 2024 study found that 

 translated to an average of 66 years of full health.

While vaccination coverage for core immunizations among both children and adults in the United States remains high overall, recent CDC surveillance highlights notable disparities in uptake between states and population subgroups.

 Gaps in insurance coverage, logistical challenges, and misinformation are persistent barriers, continuing to impact communities unevenly and contributing to lower coverage rates in some regions and among specific demographic groups.

A recent study conducted by WalletHub examined the 50 states and the District of Columbia across 16 key metrics to see where Americans appear to be most responsible about getting vaccines. The data set ranges from the rates of children, teens and adults vaccinated against various diseases to the share of people without health insurance.

The findings presented in this PPT provide timely insights into these disparities and influencing factors by comparing states on three key dimensions: 1) Children & Teenagers Immunization Rates, 2) Adult & Elderly Vaccination Rates, and 3) Immunization Uptake Disparities & Influencing Factors. The data can inform clinicians, educators, and policymakers seeking to direct resources, strengthen outreach, and promote equitable protection against preventable illness.

Shattock AG, Johnson HC, Sim SY, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. 

. 2024;43(10441):2307-2316. doi:10.1016/S0140-6736(24)00850-X

Vaccination coverage among adults in the United States, National Health Interview Survey, 2022. Centers for Disease Control and Prevention. October 4, 2024. Accessed September 12, 2025. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html

McCann A. States that vaccinate the most. September 9, 2025. Accessed September 9, 2025. https://wallethub.com/edu/states-that-vaccinate-the-most/66237

Northeastern states consistently ranked highest on measures including rates of flu vaccination across age groups, number of teens vaccinated against HPV, and older individuals with shingles vaccination. 

9 States Ranked Highest for Population Vaccination 

A 43-year-old woman presents to the dermatology clinic with complaints of a rash of one weeks’ duration. The first lesion started on the left breast (at right), then scabbed over. About 4 days later, fever, chills, neck pain, and headache abruptly started. The fevers spiked to 102°F. A tender rash then disseminated to involve the face, trunk, and extremities. She denies muscle or joint pain, vomiting, sore throat, diarrhea, or dysuria. The patient reports no other sick contacts.

She lives in an apartment in Brooklyn, New York, and denies recent travel. She works as a cook. She is monogamous with her male partner and lives with 2 children. The patient’s 2-year-old daughter has a similar lesion on her right thigh, but denies other symptoms. The patient had chickenpox in childhood and denies a history of herpes. On questioning, the patient reports that she had called an exterminator 2 weeks ago to deal with a “mouse problem.”

Physical exam is significant for an erythematous plaque with an eschar on one breast. Grey pustulovesicles on an erythematous base can be found on the dorsal hands (image at right), face, arms, legs, and flank. The oral mucosa is clear.

Rash began with one lesion followed by tender, disseminated eruption; fevers spiked to 102°F. Test your visual diagnostic skills. 

Image IQ: Rash with Chills, Neck Pain, Acute Fever  

How to Address Patient Hesitancy Around Cervical Cancer Screening with Ada Stewart, MD

Patient hesitancy remains a barrier to timely 

 screening, even when guidelines are clearly communicated. Anxiety around Pap smears—including discomfort with the exam and fear of results—can discourage women from keeping up with recommended screening schedules. Primary care physicians are in a unique position to address these concerns directly during routine visits, ensuring patients are informed, supported, and comfortable throughout the process.

, Ada Stewart, MD, a board-certified family physician, discusses practical strategies clinicians can use to reduce patient anxiety during screening exams. From incorporating shared decision-making to simple in-office adjustments such as using a smaller speculum, playing background music, or offering staff support, Dr Stewart highlights ways to make cervical cancer screening a more patient-centered experience.

The following transcript has been lightly edited for style and flow.

 Yes. It’s really important that, as a primary care clinician and family physician, I inform my patients and make sure that all decisions are shared between myself and them. I talk about the guidelines, the recommendations, and the limitations of the tests we perform. I also make sure to assess their comfort level with the Pap smear and address any concerns.

If it’s about pain with the speculum exam, I try to use the smallest available speculum. Sometimes I’ll have music playing in the background. I may even have one of my staff hold the patient’s hand. It’s all about shared decision-making—making sure the patient is well informed about what the guidelines say, what’s best for them, and what limitations may occur—while ensuring they are comfortable with the exam itself.

Ada Stewart, MD, shares strategies for primary care physicians to reduce patient anxiety and improve comfort during cervical cancer screening exams.

Ted W. James, MD

Articles

Latest Updated Articles