Dermatology

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Although this patient has been treated by several health care providers for this expanding lesion on his scalp, nothing has worked. The pathology is clearly outside the “normal” realm. What’s going on?

A 24-year-old woman presented with a chief complaint: “Check a funny mole.” Her boyfriend pointed out that a single mole on her back looked “different.”

A 27 year-old woman was petting her cat, when the animal suddenly bit her on the arm. She rinsed copiously with isopropyl alcohol and applied an over-the-counter antibiotic ointment. But, 12 hours later, a large, red, swollen and exquisitely tender plaque had developed around the bite site.

Following his routine rosacea follow-up visit, this 58-year-old man incidentally asked about a lesion on his left third digit. He pointed out a dime-sized, red, scaly patch on the dorsal aspect of the distal portion of the knuckle that extended toward the end of the finger.

An 8-year-old child has intensely pruritic lesions on the thumbs, adjacent dorsum of the hand, soles of the feet, and navel. Vital signs are normal. The patient is otherwise healthy and has no recent history of exposure to poison ivy.

Match each picture with the phrase below that best describes it. The pathogenic organisms in these picturesmight be microscopic or macroscopic, and they can be recovered from skin lesions or clothing by the patientand/or clinician. Answers and discussion appear on the following page.

The mother of this 18-month-old boy brings him to your office for evaluation of a pigmented lesion of 2 months’ duration on the right anterior shoulder. When the lesion is rubbed, it becomes red and inflamed and occasionally a blister forms.