Face to Face With Skin Conditions: A Photo Quiz

May 27, 2014

Meet patients’ facial skin problems head-on by gaining a familiarity with the common problems and symptoms. This week’s photo quiz offers a variety of presentations to test your prima facie knowledge.

Question 1:

A 48-year-old man presented for treatment of herpes zoster. As an incidental finding, numerous flesh-colored, asymptomatic papules were noted on the central face. They have no malignant potential and no serious systemic associations. The disorder is autosomal dominant.

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Question 2:

This man’s skin condition appears as erythematous plaques or patches topped by white or yellow scale. It most often affects the scalp and the face, particularly the ears, eyebrows, and nasal alae. In persons of color, it may appear simply as white, minimally scaly patches on the face underlying the eyebrows. It can become secondarily infected with gram-positive organisms. The man has seborrheic dermatitis.

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Question 3:

A close-up view of a patient with rosacea shows striking hypertrophy of the nasal soft tissue. Adjacent portions of cheeks show extensive papule formation and surface irregularity from overgrowth of sebaceous tissue and connective tissue. A tiny venous lake is seen on the left lower lip.

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Question 4:

A 9-year-old girl is brought by her mother because of the acute onset of a facial rash. There is no associated itching, and the child is, and has been, otherwise healthy. The linear arrangement of 1 or more parallel bands composed of 2- to 4-mm flat-topped papules on the face or on an extremity is classic for an idiopathic, asymptomatic eruption that favors children.

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Question 5:

A 77-year-old man sought medical attention because of a painful group of “sores” near his mouth. He was just recovering from community-acquired pneumonia. The attack was precipitated by the temporarily impaired immune response associated with his pulmonary infection. The clustered grouping included small, shallow erosions surmounting a slightly indurated plaque.

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Question 6:

A 7-year-old boy presented with a solitary, nearly circular, very pruritic inflammatory facial lesion. Annular lesions suggest dermatophytosis. The intensity of the inflammatory response suggests a nonhuman source for the fungus (the presence of which was verified by potassium hydroxide).

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Question 7:

Despite curettage several months earlier, the facial rash on this 4-year-old boy had spread across both cheeks and was now mildly pruritic. Note the discrete, smooth, pearly or flesh-colored, dome-shaped papules with central umbilication.

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Question 8:

A 5-year-old boy was brought to the ED because of a rash that covered his entire body. It had started 2 days earlier, initially on his face, abdomen, and legs, and had spread to his back, buttocks, and hands. He had a 1-day history of tactile fever. He had no sick contacts and no significant medical history. He appeared to be nontoxic; he was afebrile and his vital signs were stable. His skin had patches of erythema and exfoliation that were slightly tender to palpation and felt warm to the touch.

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ANSWER KEY:

Question 1. A

Question 2. E

Question 3. A

Question 4. C

Question 5. B

Question 6. B

Question 7. B

Question 8. D