Dermatology

The sharp transitions in pigmentation on the anterior surface of the arms of this 49-year-old black man were noted as an incidental finding. The arms' lateral aspects were distinctly more deeply pigmented than the medial aspects. In addition, a hyperpigmented band was present over each pectoral area, while a hypopigmented vertical stripe covered the sternum. These symmetric transitions in pigmentation are normal variants found most commonly in blacks and are known as pigmentary demarcation lines.

A red papule developed on the scalp of a 52-year-old man who had a history of adenocarcinoma of the lungs. The patient was a former cigarette smoker.

Some cutaneous conditions are unique to pregnancy and the postpartum period. Others may affect both pregnant and nonpregnant women. Familiarity with these conditions is important in the evaluation of a pregnant patient with a rash or cutaneous lesion.

An acute exacerbation of asthma brought this 52-year-old Russian emigré to the emergency department (ED). Examination revealed the well-demarcated round erythema and ecchymosis on the patient's back. This circular pattern was created by cupping performed 2 days earlier by the patient's wife in an effort to treat her husband's asthma.

The numerous superficial, rounded, red-based ulcerations on the left buttock of a 3-year-old girl are characteristic of bullous impetigo. The varnish-like crust on the largest lesion is also typical of this skin infection.

The nonpruritic hypopigmented lesions on this 13-year-old girl's cheeks are characteristic of pityriasis alba, which typically occurs in children of both sexes between the ages of 3 and 16 years.

A rash on both palms concerned a 35-year-old hairdresser, who said she always wears vinyl gloves while working. She recalled using a new hair coloring product on a client a few days earlier. Within 24 hours of applying the substance, the rash began to erupt; it worsened over the course of 2 days.

A 50-year-old man with a history of diabetes, hypertension, seizure disorder, and alcohol abuse sought treatment for a rash and painful ulcerations of the hand, face, and scalp, which had bothered him for 1 month. The patient also complained of pruritus.

Left eyelid swelling and drooping, which had been worsening slowly over the last 5 to 6 months, prompted a 77-year-old man to seek medical evaluation. There was no pain and no discharge from the eye. The patient stated that his vision was not adversely affected, and he denied diplopia. There was no history of ocular injury or surgery.

A 48-year-old man requested medical evaluation of the multiple spots that gradually appeared on his legs over the past 5 years.

Two weeks after the subcutaneous injection of 0.5 mL of varicella vaccine in a 2-year-old girl's left arm, a nonpruritic rash developed on the child's upper abdomen and left forearm. She had no fever. The lesions subsided after 5 days.

This 7-month-old infant had light red macules on the glabella that were first noted at birth. By the time the child was 2 years old, the lesions were only faintly visible.

An 18-month-old girl was noted to have somatic overgrowth, macroglossia, macrostomia, fading telangiectatic nevi over the glabella and eyelids, vertical creases on the earlobes, a short nose with anteverted nares, and a long philtrum. She also had an ejection systolic murmur best heard at the left mid- and upper sternal border, compatible with an atrial septal defect.

A 2-week history of diarrhea mixed with bright red blood was the presenting complaint of a 40-year-old man who was seropositive for HIV. Stool studies and culture results were negative for microorganisms. Colonoscopy demonstrated only the raised vascular lesion seen here in the sigmoid colon, which may have been responsible for the bleeding.

A 42-year-old woman sought medical advice for a facial rash of 4 weeks' duration. She denied any drug allergies, changes in her routine, or use of new laundry products.

A 67-year-old woman presented with a painful genital ulcer. She denied new sex partners and previous genital lesions.

Purplish skin lesions appeared on the back and trunk of a 34-year-old homosexual man with HIV-1 disease. The spots had been growing larger over the past several weeks.

This 6-year-old child presented with a painless mass on his lower lip. The mass had increased in size slowly during the previous 2 months.

n asymptomatic pink lesion measuring approximately 1 cm in diameter appeared on this 80-year-old woman's right cheek 3 weeks before this picture was taken.

This 7-year-old presented with a pink, raised lesion on her upper left eyelid. The 1-cm lesion contained tiny vesicles and showed eccentric central clearing.

Seen here is an ulcerated tumor with irregular borders on the left foot of a 37-year-old man. He said the tumor had developed several years ago.

Ten days after ballet practice, a 9-year-old girl noticed a nonpruritic, petechial rash on her lower legs. Swelling of the ankles and knees was also apparent. The patient was afebrile, otherwise healthy, and had no abdominal pain. There was no family history of blood dyscrasias. The patient was taking no medications.

For more than 20 years, a 55-year-old man had a faintly erythematous, papulosquamous rash with arciform borders on his groin and waistline. The rash had been treated with a variety of medications. Topical and oral antifungals and antibiotics and topical corticosteroids had been used but to no avail. No laboratory tests had been performed.

Flat, tan-pink patches on his lower legs disturbed a 52-year-old man. The lesions had visible, nonpalpable petechiae, which did not blanch on diascopy; telangiectasia and inflammatory vasodilation, therefore, were excluded from consideration.

A 51-year-old woman with severe migraines sought evaluation of a dozen round black macules on her hands, forearms, and legs. A few of the lesions had first appeared 1 year earlier; the remainder had erupted since then.