Dermatology

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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.

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.

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 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.

Not for Women Only

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.