Dermatology

A 75-year-old man complained of the sudden appearance of multiple “moles” on his back. He had no history of skin cancer. Past medical history was significant for prostate cancer, which had been diagnosed and treated 2 years previously.

Mongolian spots are congenital, hyperpigmented, usually gray areas of varying size and shape. They result from the abnormal occurrence of melanocytes in the lower half of the dermis and are found most frequently in the sacrococcygeal and gluteal areas.

A 19-year-old man was referred for further investigation of multiple pigmented cutaneous lesions.

These collections of dilated vessels deep in the dermis and subcutaneous tissue are present at birth. They usually present as bluish or reddish lesions that are cystic, firm, and compressible. About 60% to 80% of cavernous hemangiomas undergo spontaneous involution, often with central clearing and fibrosis.

Although tinea versicolor is fairly common, its appearance on the face and neck is unusual, notes Robert P. Blereau, MD of Morgan City, La. His patient, a 30-year-old woman, exhibits the pale, rounded, fine-scaled lesions typically found on tanned or dark-skinned persons.

During a routine physical examination of a healthy 7-year-old African-American boy, this striking-and puzzling-hyperpigmentation was noted on his palms.

These are hyperpigmented, regularly bordered, sharply demarcated macules that are usually tan or light brown in whites and dark brown in dark-skinned persons. The lesions are characterized by an increased number of melanocytes and an increased amount of melanin in the epidermis.

A 6-year-old African American boy is referred for evaluation of “cellulitis,” which had persisted for several weeks. The condition had failed to respond to oral antibiotics prescribed by another practitioner.

A 58-year-old man presented with a 6-month history of a mildly pruritic rash of the left axilla. The patient was in good health, took no medications, and denied any other symptoms.

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.