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.
“Stippled” pigment is highly typical of a pigmented basal cell carcinoma. Diagnostic contenders include atypical seborrheic keratosis and superficial spreading melanoma.
Edema of the hands has numerous etiologies: leukocytoclastic vasculitis, puffy hands from HCV infection, DVT, lymphedema, trauma
Löfgren syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias.
The morphology of a round, red to purple patch, with or without blistering, is typical of a fixed drug eruption. This entity usually manifests as a solitary spot, but can be multiple. Tetracycline antibiotics and barbiturate sedatives are common causes. This patient had been taking doxycycline.
This friable lesion with rapid and destructive growth is classic for granuloma inguinale. This patient was treated successfully with trimethoprim/sulfamethoxazole.
Ecchymosis is caused by the rupture of small blood vessels beneath the skin. Some causes are benign, others may herald dangerous disease.
Condylomata acuminata this extensive are beyond the capacity of all topical therapies. The area was initially treated by carbon dioxide laser ablation, and residual small foci of infection were subsequently treated with topical 5% imiquimod cream.
The combination of itching massive scaling suggests the diagnosis of crusted scabies. This variety of scabies is seen in those who are immunosuppressed or immunocompromised (typically HIV+). Repeated oral doses of ivermectin along with topical permethrin application were required to clear this infestation.
A 24-year-old woman sought medical attention because of the acute onset of a very painful vulvar rash. She had never experienced anything similar. Do you recognize these lesions?
The patient received standard acyclovir dosage for first outbreak genital herpes: 200 mg orally, 5 times daily, for 10 days total. At this point, there is no way to predict how often or how severe future recurrences will be.
A lot of sound-alike medications are on the market that can easily be prescribed incorrectly. Hydralazine and hydroxyzine are a good example, as this case attests.
This painless, indurated ulcer is typical of the chancre of primary syphilis. This patient also had a positive RPR in a titer of 1:32.
Any adult with patchy hair loss with preservation of follicular openings should be questioned about sexual exposures. This presentation is not typical of alopecia areata, and the patient is too old for tinea capitis to be a major consideration.
Chlamydia trachomatis, serovar L2b-a recently discovered microbe-was the cause of atypical lymphogranuloma venereum in this HIV-positive patient.
This multi-factorial eruption requires topical or systemic antifungal treatment in conjunction with broad-spectrum antibacterial therapy, topical desiccating maneuvers (such as Burrow’s soaks), and discontinuation of OTC interventions that might be worsening the problem.
Squamous cell carcinoma is the most common tumor of the penis. Melanoma, sarcoma, and (rarely) basal cell carcinoma and cutaneous metastasis also occur here.
The confluence of small, scaly, hyperpigmented patches on the chest (and often neck and upper back) is classic for tinea versicolor.
These firm, pigmented plaques, in a young African American, are most likely cutaneous sarcoidosis. This diagnosis was verified by biopsy.
The patient was a traveling salesman and was concerned that the lesions were bedbug bites. The diagnosis of herpes simplex virus infection was confirmed by viral “culture.” What was this patient's condition?
There is a rather large erythematous patch/plaque present. However, an exophytic, verrucous nodule is visible at the inferior border of the tumor. Biopsy of the flatter portion of this lesion disclosed squamous cell carcinoma in-situ, while biopsy of the nodule revealed invasive squamous cell carcinoma.
One of two common presentations of tinea pedis, this morphology is more common in those whose interdigital space is tight, leading to moisture retention and maceration. Diligent use of any topical antifungal will clear this.
The 2% preparation of an allylamine antifungal is a new addition to the menu of available topical agents. It has the advantage of once-daily dosing and shorter course of therapy.
A 57-year-old man presented for medical evaluation because of the presence of a "funny looking lump" on the lateral aspect of his right upper thigh.
