Dermatology

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Prominent, pigmented polyangular scales on the extensor surfaces of the arms, legs, and trunk suggested recessive X-linked ichthyosis. DNA analysis demonstrated an abnormal steroid sulfatase gene, which confirmed the diagnosis.

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Diabetic myonecrosis; Persistent bacterial bronchitis; basal cell carcinoma; statin-drug pleiotropy; spinal epidural abscess

Bed Bugs

This patient wonders whether the insect he found on his headboard might be responsible for the clusters of pruritic, crusted papules on his legs. This turned out to be a bed bug.

This new-onset “growth” was removed and shown to be a solitary neurofibroma, which is not an indication of any of the genodermatoses marked by a multiplicity of such neoplasms.

While it might be tempting to dismiss this as a picker's nodule, lesion's thickness suggested the need for a biopsy, which revealed that the lesion was an infiltrative, invasive basal cell carcinoma. The lesson? Never hesitate to biopsy when the slightest uncertainty exists as to the correct diagnosis.

The predominantly infraorbital erythema and swelling suggested that this rash was related to a material that was being placed in the eyes and dripping from them. Patch testing showed that the patient was allergic to the preservative in the eyedrops she had been using.

The redness on this woman's nose represents fairly severe photodamage with extensive actinic keratosis. Use of a topical therapy to achieve clearance of a field of actinic damage can be done with imiquimod, 5-fluorouracil, or ingenol mebutate creams, or diclofenac gel.

Cutaneous horns can arise on top of: seborrheic keratosis (as in this patient’s case), actinic keratoses, warts, basal and squamous cell carcinomas. Therefore, the lesion-and especially the base-must be submitted for pathologic diagnosis.