20 yo man with cutaneous larva migran

The patient is a 20-year-old man who noticed multiple intensely pruritic creeping lesions on his abdominal wall for more than a month. He is a body building enthusiast.Examination showed multiple 2-3mm wide serpiginous raised erythematous tunnels on the left periumbilical and right upper quadrant of the abdominal wall.Treatment was with freezing 1cm distal to the end of the trail with liquid nitrogen and adding oral mebendazole (zentel) 200mg bd...

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10 year old girl with endogenous cheilitis

This patient presented with recurrent dry and fissured lips for more than 2 years. She has a strong family history of atopy. Her brothers and sisters have asthma and allergic rhinitis. Fortunately she didn't use any lipstick.Examination showed fissures and dryness on both the upper and lower lips. There were crusts formations on the lipsClinically she has endogenous (atopic) cheilitisThere are few factors that need to be considered here. is there...

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34 year old man with multiple erythematous plaques

Recently I saw this interesting patient: a 34 yr old factory worker presented with redness over the thigh and lower abdomen for a week. Started as "burning discomfort" over the left knee and then spread to the right knee, thigh and lower abdomen. He has no fever. No history of diabetes. He denied any insect bite. There was no preceding drug history.Examination showed diffuse and glistening redness on the thighs and lower abdomen. On the right...

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18 yo girl just returned from Costa Rica

This 18 year old girl just returned from a school trip to Costa Rica. Her group explored streams and swamps. She developed asymptomatic papules and pustules on the dorsae of her feet after being in stagnant muddy water and a running stream. I am wonderind if this is a gram negative organism or a parasite. Any though...

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36 yo man with lesion on back

This 36 yo man presented with a 1.6 cm in diameter pigmented plaque on his back for approximately 2 years. Barely elevated. Has enlarged over past few months. Dx: Melanoma vs. Seborrheic keratosis. An excisional bx was performed today.Path ReportDIAGNOSIS: Skin - Right Mid Back: Malignant melanoma. Type: Superficial spreading Greatest thickness: 0.90 mm. Anatomic level: II Margins: Complete excised Radial growth phase: Present Vertical growth...

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2 yo girl with segmental hypopigmentation

This is a 2 year old girl who has a patch of hypopigmentation on her left shoulder since birth. It extends from back of neck to the left shoulder. It was asymptomatic. Examination showed a hypopigmented macule 5cm by 10cm on the back of left shoulder. It is segmental in distribution and has an irregular border. There was no central hypoaesthesia. She has no ophthalmic or CNS defects.Clinically she has nevus depigmentosus or some form of pigmentary...

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Newborn with Varicella

Posted for Dr. Jayakar Thomas of Royapuram, Chennai, India. Please comment here or reply directly to Dr. Thomas at thomas_j@vsnl.comThe patient is a 21 day old female infant who presented with multiple generalized vesicles of two days duration. Her mother had developed varicella two days post-partum.Physical Exam: A normally nourished child with multiple vesicles over erythematous base. Child had low grade fever. There were no oral or genital lesions...

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3 yo with nail dystrophy

This 3 yo boy has had a malformed left great toe nail since infancy. Recently, he traumatized it and may have had a subungual hematoma. His pediatrician tried to drain it with a hot paperclip, but was unsuccessful. His parents want to know what could be done to improve this nail.Nail Dystrophy, ChildNail Dyst - Clos...

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F/U March 16, 2005&nb...

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March 15, 2005&nb...

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Savannah&nb...

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Closeup&nb...

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Atopic Infant

The patient is a one year old boy with an almost life-long history of atopic dermatitis. His father (age 30) has persistent facial eczema. His mother has significant food allergies (nuts and fruit cause angioedema and laryngeal edema). This child's facial eczema has proved difficult to control. Topical steroids have been of value (fluocinalone 0.25% ointment); but topical tacrolimus and pimecrolimus have not been effective. I suspect he may...

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Genital Papules in a 25 yo woman

Presented by: Dr. Jayakar ThomasKK CHILDS Trust Hospital, & Apollo Hospitals, Chennai, IndiaE mail: thomas_j@vsnl.netThe patient is a 25 yo married woman from Chennai, India who presented with itchy papules over the vulval area for the last two years. There was no history suggestive of risk of acquiring any STD.Physical Exam: Clinical examination revealed a healthy very good-looking young lady with multiple papules over her genital region.Lab:...

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2o yo man with painful plaque

OFFICE VISITMARCH 07, 2005Sam D. was seen today on a same day basis. He has a few day's history of a tender, erythematous area on the right lower leg. This is at the site of a twine ankle bracelet that he had been wearing for two years. He feels a bit run down although he has not had a fever. EXAMINATION: The examination shows an area of localized erythema and mild central scaling on the left lower leg just proximal to the ankle medially....

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56 yo woman with erosions for two years

This 56 yo woman has an alomst two year history of intense pruritus. She dates the onset to April 23, 2003 when she was exposed to toxic fumes at work. Since then, she wakes at night excoriating her skin. Other than a mild anemia and eosinophilia, all studies have been unremarkable. She has not worked since April 30, 2003. The is an intelligent person. Divorced, mother of three adult children (one with Turner's Syndrome) she worked in retail...

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56 year-old woman with metastatic melanoma

This 56 yo woman presented on February 10, 2005 with multiple subcutaneous nodules, present for around a month. Some were hemorrhagic. Biopsy showed metastatic melanoma. Work-up revealed pancreatic, brain, lung and possibly adrenal mets. The biopsy site has not healed. A four centimeter exophytic tumor has appeared at the site of incision. The patient is lucid and has refused chemotherapy or radiotherapy. The tumor pictured below is a management...

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72 yo woman with Lupus Pernio

This 72 yo woman has a five year history of biopsy proven lupus pernio. She also has a 30 year history of stable chronic leukemia (I don't know the form). Her rheumatologist treated the sarcoid with hydroxyplaquenil and Methotrexate (without any benefit). The questions: 1) topical tacrolimus 2) Infliximab and possible contraindications b/c of chronic leukemia. Strangely, her insurance carrier has denied tacrolimus ointment, but this is bein...

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53 year old man with 4 month history of lesion back

This 53 year-old man noted a lesion on right upper back around 4 months ago. It has tripled in size since then. On first glance it looks like a BCC, but BCCs rarely grow like this. The patient has Type I - II skin and is covered with freckles. He has a strong family history of skin cancer. I excised this lesion immediately because I was worried that it might be an amenanotic melanoma. If the latter, this is scary since it will be a thick lesion....

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51 year old woman with incidental lesion

This 7 mm in diameter lesion was noted on the left upper back of a 51 yo woman with type II skin. She was concerned about another lesion on the lower back. The latter lesion was benign in appearance. The lesion pictured below was biopsied and I will post the results in a week. The patient was unaware of this lesion, it being on a part of the back that is difficult to visualize.incidental lesion&nb...

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