Dermatology

After 6 weeks of scratching a very itchy, worsening rash on his left leg, a 53-year-old man seeks medical evaluation. He has tried over-the-counter (OTC) topical remedies with no success.

Certain papulosquamous and bullous diseases are more common in older adults than in younger persons. For example, bullous pemphigoid typically affects those in the fifth through seventh decades of life. Grover disease, or transient acantholytic dyskeratosis, is most common in white men older than 65.

Two skin carcinomas that are in close proximity can be removed in a single excision.

For 3 weeks, a 28-year-old man has had a pruritic, bilateral axillary rash. He stopped using deodorant, but the condition has not improved.

During a routine examination, these changes are noted on both thumbnails of a 56-year-old man. He denies any trauma or underlying diseases.

After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather.

For several months, a 28-year-old man has had these changes to his nails, which have also become more brittle. He denies any history of trauma to the nails.

A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications-none of which are new.

Asymptomatic lesion on the dorsum of a 15-year-old boy’s left hand extends on to the first 2 fingers and has produced nail dystrophy. The patient is otherwise healthy and denies any history of trauma to the hand.

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier.

A 26-year-old white male aviator presents to his primary care physician for his annual military physical examination. The patient is healthy, takes no medications, and has no history of serious medical disorders. Genital examination reveals multifocal, confluent, slightly variegated, hyperpigmented macules with irregular borders located in a circumferential distribution on the penile shaft and glans.

A tender, crusting eruption first arose on a 69-year-old man’s ear 10 days earlier; an antibiotic failed to clear the lesion.

A 37-year-old man presented to the emergency department with painful, burning, blistering skin lesions. The lesions started 3 days earlier on the face and spread to the trunk and extremities. Ten days before presentation, the patient had received a diagnosis of AIDS.

Men who have undergone localprocedures in the genital or analarea (eg, abscess drainage) find itdifficult to get a bandage to adhereto the skin because of the pubichair.

Several months earlier, this asymptomatic, pigmented, hard nodule arose on the upper arm of a 37-year-old woman.

For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. Amoxicillin/clavulanate was started 2 days earlier pending the results of a bacterial culture.What is the likely diagnosis?

Eczema is confined to the dorsum of a 37-year-oldwoman’s hands. She had been applying an over-thecounter,topical antifungal cream but noted no changein the rash. The patient is a hairdresser and enjoyskickboxing.

Chronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective. The corticosteroids provided initial relief, but the psoriasis recurred once the medication was discontinued. This patient had been in a county jail for about 18 months; during his confinement, he was not exposed to sunlight.

For a few weeks, a 36-year-old woman has had this pruritic labial rash.

A 43-year-old woman with chronic hip pain presents with an asymptomatic eruption on the hip of several months' duration. She has been using a heating pad at night for pain relief because NSAIDs have not been effective.

My patient is a woman in her late 30s who has several episodes a month of confluent facial erythema that is very warm to the touch and highly pruritic.

A previously healthy 40-year-old man complains of worsening lower-extremity discomfort. He noticed the discomfort several days earlier on awakening and thought that he had been bitten by a spider. The lesion, initially a small pustule, has enlarged into an open wound.

Dr Rosen invites you to match the clinical characteristics in the checklist with the disorders pictured in the photos. This month’s challenge: 2 leg lesions.

A 16-year-old boy with asymptomatic, hyperpigmented, hairy lesion on his left upper back. The pigmentation, first noted 5 years earlier, had progressively spread across his torso. The coarse and dark hair confined to the hyperpigmented area had appeared at age 13 years. Medical history uneventful. Review of systems showed no abnormalities. No family history of similar skin lesions.

When a patient complains of a “sore that won’t heal” or mentions that a lesion “constantly bleeds and scabs,” heed the advice of Osler.

Inside: a photo guide to the various manifestations of stasis dermatitis, irritant contact dermatitis, and allergic contact dermatitis-including diagnostic clues and treatment options.

A 32-year-old woman presents for evaluation of itching in the pubic area.

For 9 months, a 39-year-old woman has had a pruritic rash on the posterior portion of one thigh. She had consulted another physician, who prescribed a medication that she does not recall, but there was no improvement.

These scaly plaques on the scalp of a 32-year-old man have failed to respond to a topical antifungal. The patient has a 3-year history of pulmonary sarcoidosis.

A 24-year-old man is concerned about a large, hairy "mole" on his left shoulder. The lesion appeared during adolescence as a group of small, dark blotches. These eventually coalesced into a hyperpigmented patch with hair and acne.