Zebibah

The zebibah, Arabic for raisin, is a dark circle of callused skin, or in some cases a protruding bump, between the hairline and the eyebrows. It emerges on the spot where worshipers press their foreheads into the ground during their daily prayers.Here is a fine article in the NY Times on the ZEBIBAH.One of our editors, Ben Barankin, published a letter on prayer marks in the International Journal of Dermatology. Barankin LetterDr. Barankin's letter...

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Iatrogenic or Not?

Your opinion is sought.The patient is a 42 y.o. woman with a long history of cystic acne. Typically she gets a few lesions a year. She has many ice pick scars from previous lesions. She was offered isotretinoin years ago but declined and indeed the lesions are less frequent now. She presents for intralesional triamcinalone when whe wishes to have the cysts treated. She was seen on December 5, 2007 with a tender cyst on the medial aspect of the...

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Palmar Lichen Planus?

This case was presented by Dr Khalil Alhamdi, Basrah Medical College, Iraq.S.G, 62 yo woman, presented with bilateral itchy palms 2 years duration with poor response to treatment. Physical examination is normal apart from bilateral diffuse hyperkeratotic violaceous palms. All laboratory investigations were normalHistopathology: histopathological examination showed typical features of lichen plaus.Diagnosis: palmer lichen planus. What is the experience...

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Epidermal nevus affecting foot

A 22 year old man presented with a history of linear hyperkeratotic lesion on the right foot since age 7 yrs. It hurts his foot when he wear his shoes.Examination of the right foot showed a localised hyperkeratotic plaque extending linearly to the medial malleolus. It was not tender or inflamed. My impression is that of an epidemal nevus. Appreciate your thoughts on diagnosis and treatment optio...

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Annual Hot Spots Program

Conference Web S...

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Winter's Toes

Abstract: 18 yo boy with pruritic, erythematous toes.History: The patient was referred by his pediatrician with complaints of red, itchy lesions on his toes for two to three weeks. The pediatrician was concerned because some of the lesions looked vasculitic. The patient is in good general health. A non-smoker. He recollected as the interview progressed that he'd had similar but less severe problems in the past.Physical Exam: Erythematous macules,...

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Notched Nose

This 55 year-old woman had micrographic surgery for a basal cell of the left ala three years ago. The graft did not take and she has been left with a notched ala. The defect, in the center of her face, is more disfiguring than it appears in this photo.Question: What kind of repair could be done at this time to give her a better functional and cosmetic repa...

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Uncommon Warts

SRLAMAT DATANG!Welcome, New Members from the Penang ConferenceEarly morning, view before we convened for our scientific sessions. Penang is an amazing place to meet new friends, relax and sample a singular culture.Please look at two interesting cases.This is the tale of two young patients with warts who were seen back to back on November 17, 2007. Verruca vulgaris (the common wart) is sometimes quite "uncommon."1. This is a seven year old boy who...

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Eczema herpeticum

A 2-year-old boy presented with a 3-day history of vesicular eruptions on the mouth followed by extensive pruritic skin eruptions on the upper and lower limbs. This was preceded by fever. He was otherwise well.Examination of the skin showed extensive eczematous lesions on the lower and upper limbs. Excoriations, erosions and vesicles were also noted on the affected areas. Vesicular lesions and erosions were noted around the mouth. He was afebrile.Clinically...

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Buttock eruptions

This is an 11-month-old girl with a one day history of skin eruptions on the shoulders and gluteal areas. She was otherwise well. no fever. Feeding well. She was referred to me by a pediatrician.Exam: symmetrical patches of erythematous vesiculopapules on the gluteal areas. Similar lesions were noted on the shoulders and chest. No lesions were noted on the upper limbs. Hep B was not checked.Is this viral? Gianotti Crosti Syndrome?Than...

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Nasal Lesion in a Child

The patient is a 30 month old girl with a 15 month history of a papule on the left ala nasi. Her father has Hereditary Leiomyoma Renal Cell Carcinoma syndrome (HLRCC) and the patient is positive for the gene. The question is whether this papule is a possible sign of the HLRCC syndrome or an unrelated entity.The tumor is 3-4 mm in diameter and has been growing very slowly. The child is in good general health otherwise. The lesion is red in color,...

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Paronychia in a Child

The patient is an eight year-old girl with a three week history of paronychial inflammation. Mild pain at onset and now. No history of trauma or finger sucking. She was first seen by her pediatrician around ten days after onset and told it was improving and to give it time. No improvement after ten days; given a ten day course of cephalexin and urged to do warm soaks. No improvement noted. Seen in Dermatology Clinic October 26, 2007. Examination:...

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Hand Bullae in the Setting of Hemodialysis

Presented by Tucker Slingerland, M.D. Chief Resident in Family Practice at the University of Vermont.HPI: A 76 year old woman with multiple medical problems including chronic hemodialysis, hypertension, hypertriglyceridemia, and type II diabetes mellitus presents for a second opinion on bullous lesions involving the dorsal hands, fingers, tips of ears and scalp. She had been told she had "porphyria," given sparse information about her condition,...

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Perplexing Periodic Pruritus

This case was posted by David Elpern MD as a rapid publication for VGRDWe have been having technical problems with VGRD and have elected to publish this case here. Your comments will be appreciated -- please mail them directly DJ Elpern and we will post them to VGRD when it is up and running,78 yo man with episodic incapacitating pruritusDuration: 4 yearsDistribution: Generalized, but sparing head and feetThe patient is a 78-year-old semi-retired...

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Nail Abnormality in a young girl

This case was submitted by Dr Choon Siew Eng FRCP, a dermatologist from Johor Bahru, Malaysia A 14-year-old Malay girl presented with a 7-month history of asymptomatic nail abnormality affecting all fingernails. Good general health. No previous of current skin problem or hair loss. No family history of skin problem. No personal or family history of atopy. No family history of autoimmune disease. No nail biting habit. Never varnish nails and no excessive...

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Mistakes

Osler urged us to "Carry a small note-book, and never ask a new patient a question without note-book and pencil in hand......Begin early to make a three-fold category - clear cases, doubtful cases and mistakes. And learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch. It is only by getting your cases grouped in...

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Rosacea

This posting is from Liliana Rivis, a F.P. resident from Augusta, ME. It is intended for her colleagues as a learning experience, but others are welcome to read and comment if they wish.The patient is a 43 yo CNA with a two year history of a facial eruption. She had tried metrolgel on a number of occasions and doxycycline for seven days at a time without significant improvement. She is a smoker( 1PPD x years).O/E; She has an erythema on the...

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Evolving Lupus Variant?

Your thoughts are most welcome with regards to this patient. I don't have a firm diagnosis yet, but suspect this will turn out to be a form of lupus -- possibly subacute or acute LE..HPI: A 47 year old woman was seen on June 11th, 2007 with with one month history of two 8 cm. plaques on her legs, KOH negative. Did not look like panniculitis. Initially thought to be Lyme disease, the lesions did not respond to doxycycline.Because of progression...

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The Orphan Patient

Walter Shelley wrote this important poem about those patients who challenge all of us. We published it in Dermanities a while back and recently Bhushan Kumar from Chandigarh brought it to our attention again. Thank you, Bhushan! Some of the patients who find their way onto this Blog or VGRGHere it is for those who may have missed it in Dermanities. Prayer of the Orphan Patient to the Doctor Walter B. Shelley Dermanities May 5, 2007; 5(1) Prayer of the Orphan Patient to the DoctorWalter B. Shelley & E. Dorinda...

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Mokihana Dermatitis

Presented by Caitlin StiglmeierI am a 23-year old woman with Type 1 skin who was gathering the fragrant mokihana berries in Kokee, Kauai’s mountain park. Twenty-four hours later, I developed a rash of red marks on my arms, half of which later developed into vesiculo-bullous eruptions. The bullae were left alone; the large blister on the forearm was accidentally burst; the remaining smaller eruptions eventually collapsed over a week’s period.Pelea...

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