Lactating Mother

The patient is a 23 yo woman who is nursing a 4 month old infant. She has had psoriasis since childhood, often quite severe. A single mother, she comes from a disadvantaged family and is trying to do all the right things for her young daughter. Her breasts are painful from the plaques and nursing.[I apologize for the blurry picture. The battery was low and would not allow me to use macro function -- but you can get the idea.]I think this is psoriasis...

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In These United States

The quality of care in the U.S. varies quite a bit. Everyday, I see patients who might do better elsewhere but can not afford specialist care. There are lots of docs here who specialize in diseases of the rich and well-insured.Case in point. 55 year old woman with no health insurance. She has an epidermal inclusion cyst of the left inner canthus. It was 2 mm from the lacrimal duct.I said: You should see an ophthalmologist.She said: I have...

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Iatrogenic Striae

A 17 year old boy was seen by his pediatrician for a crural rash.He was prescribed Clotrimazole/betamethasone diproprionate cream to use b.i.d for three weeks. At the end of that time, he called his doctor and said he still had the rash. He relates that he was told to continue for another three weeks. Shortly thereafter, he noticed a discoloration in his groin and some tingling and erythema of the scrotum. The exam showed striae in crural folds...

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The Mask

6/15/07Every day one sees something unique: either a new disorder or a singular variant of common process. A 90 yo woman was seen yesterday 3 - 4 week after the onset of Herpes zoster of the second division of the trigeminal nerve. She was left with an impressive escar covering a large portion of the dermatome. It was relatively easy to debride most of the escar off. No anesthesia was necessary. I'll affix a follow-up photo when I see her back....

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Case for Diagnosis

Presented by Choon Siew Eng FRCP, Johor Bahru, Malaysia.46 years old woman with 3-year history of gradually enlarging asymptomatic indurated plaques on her neck, both axillae right side of abdomen, right groin and lower back. She is otherwise well with good general health. There was no significant family history. Physical examination revealed multiple indurated erythematous to hyperpigmented plaques on right side of her neck, right flank, both groins...

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Case For Diagnosis

Presented by Dr. Amanda Oakley, Hamilton, New ZealandA month ago, a 14-year old girl presented to the paediatricians with a fever, arthralgia and small purpuric and possibly target-like spots on her legs. She had been previously well and had taken no medications. After extensive negative investigation she was commenced on penicillin in case she had bacterial endocarditis, and was sent home.She was readmitted yesterday with on-going fever and arthralgia,...

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Case for Diagnosis

The patient is a 54 yo woman with a 2 week history of a rash on the arms and chest. Two months ago, she had erythema nodosum with atypical features (on her legs). The work-up eventually discovered Crohn's disease. She was started on Asacol around a month ago and around 2 weeks ago developed erythematous papules on arms and anterior chest. 0/E: The new lesions are 6 - 8 mm in diameter erythematous papules with the suggestion of central punctae....

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Continuous Medical Education

VGRD and this VGRD Blog have been around for a number of years now. Both serve as forums at which dermatologists and other physicians can post and comment on interesting and challenging cases. Other sites such as the Skin Cancer Clinic blog out of Queensland, Australia serve a similar function and are better attended. We came across an article recently which lends credence to this activity and indicates that this interactive format may be a better way of providing continuing professional education than the lectures which we traditionally attend...

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