Buttock Necrosis

The patient is a 50 yo nurse who presented to my office on July 31, 2007. Here is the history in her words:"On June 28th I fell off of my horse. Large dark hematomas covered left buttocks cheek, vagina, and coccyx. Per doctors orders warm, moist heat applied. Thw first picture, taken by my daughter ten days after the fall, shows where the circular area of skin fell off as a result of the compress. I then applied collagenase santyl cream for two...

Read More

A Textbook Case

A 76 year old woman presented to the dermatologist with a four month history of darkening of the skin of her neck, axillae, inframammary areas and groin. She had vague G.I. symptoms and had seen her primary care doctor around four times with these complaints. Although her abdomen was "bloated" she'd lost 5 - 10 pounds over the past month. Her sister had died of pancreatic cancer. (Her daughter who works at a neurosurgery office had tried to get...

Read More

Fingertip Eczema

The patient is a 52 yo warehouseman with a two year history of a painful fingertip eczema of the first three fingers of his right hand and first four fingers of his left (dominant) hand. He handles cardboard boxes and drives a fork lift. He is also an avid golfer. The dermatitis is not seasonal.He has been only minimally helped by super-potent topical corticosteroids.Patch testing is scheduled but all we have available here is T.R.U.E. Test. ...

Read More

Turtles, Birds and Bears

Dermatologists in the U.S. spend a fair bit of time screening patients for skin cancers. In spite of this, there is little evidence that this screening decreases the mortality from skin cancer (mainly melanoma). "Cancers follow three basic patterns: turtles, birds and bears.1. Turtles move so slowly that you can still capture them while they’re moving slowly along;2. The birds fly away so quickly that you can’t catch them in time;3. The bears can escape if you ignore them, but if you catch them in time, you can capture them."This simple but brilliant...

Read More

Atypical Cheilitis

The patient is a 58 yo gynecologist who has had a scaly lower lip for over seven months. When it began, she was wearing orthodontic braces. These were removed around four months ago, but the scaling on the lower lip has persisted. She is a non-smoker. She has treated patients with genital warts with a laser for years and had questions about virus in the plume.O/E: Hyperkeratosis of lateral portions of the lower lip. This is not the picture...

Read More