Onychomadesis

The patient is a 21 yo college student who emailed me around a month ago. He was away at school at the time: Nov. 15, 2008 Dear Dr. Elpern, I was wondering if you had any idea what this skin rash / irritation is being caused by. On my hands and feet I've got these little red dots scattered all over. They don't itch, but offer a mild pain when applying pressure. Most of them are plush (sic) with the skin, but some of them are raised up slightly....

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Retroauricular Dermatitis

Abstract: 16 yo boy with 3-4 year history of retroauricular dermatitisHistory: This 16-year-old boy was seen for evaluation of a retroauricular dermatitis that has been present for 3-4 years. He is in his usual state of health. He does not have a history of atopy. He does not wear glasses.O/E: Honey-colored crusting in the superior retroauricular sulci bilaterally.Clinical Photo:click image to enlargeLab: Culture positive for many Staph. aureus with...

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Scalp Folliculitis in a Patient on Chemotherapy

HPI: This 55 yo woman has had a folliculitis of her scalp for the past 2 - 3 weeks. She is receiving taxol and carboplatinum every three weeks for ovarian cancer and has had two infusions thus far. This eruption began after the second infusion.O/E: Alopecia secondary to chemotherapy. Scattered over the scalp are erythematous papules and pustules. There are no other lesions other than on the scalp.Clinical Photos: Lab: Bacterial culture obtained.Pathology:...

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Pyoderma Gangrenosum

Abstract: 46 yo man with 1.5 year history of leg ulcersHistory: The patient, a disabled 46 yo Cambodian man, has a four year history of poorly controlled ulcerative colitis. He has had painful leg ulcers for the past two years. These begin with pustules or vesicles by history. At present he is taking 1200 mg of Asacol t.i.d. and prednisone 30 mg. per day. In addition to the prednisone he has used potent topical steroids for his ulcers and...

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Alopecia in a Child

This 11 yo boy has had this alopecic area since infancy. He has been with adoptive parents since he was a baby and his mother says this has been here since coming to live with her. At first, I thought this was a nevus sebaceous, but the scalp looks normal here with none of the raised "pebbly" surface seen in this disorders in older children.My working diagnosis here is "Congenital Triangular Alopecia."References: (supplied by Brian Maurer)1. Elmer...

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Acanthosis Nigricans in a Child

Abstract: 11 yo girl with three year history of acanthosis nigricansHistory: This is a healthy 11 y.o. girl. Her mother noticed gradual darkening of skin in neck folds, axillae and groin around three years ago. The child is Chinese. Has not had her first menstrual cycle yet, although has some breast development. She is mildly overweight (not obese). Fitzpatrick Skin Type IV - V. No hirsuitism.O/E: Velvety hyperpigmentation of skin folds. There...

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Hypopigmentation in a Young Child

Presented by Dr. Henry FoongIpoh, MalaysiaHistory: A 6 year old boy presented with patches of hypopigmentation on the trunk and extremities since one year's of age. It was occasionally pruritic. He is otherwise well and has no history of fever or other constitutional symptoms. There was no family history of similar problem and no personal or family history of atopy.Examination showed the skin was quite dry. Multiple irregular patches of hypopigmentation...

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Distinctive Disorder

The patient is a seven-year old girl with a one year history of a linear band of confluent hypopigmented scaly papules. She has Fitzpatrick Skin Type IV.The clinical diagnosis is Lichen Striatus.Reference: You can read a good chapter about L.S. on: Emedicine.comQuestions: This does not particularly bother the child or her parents. Would you treat this? And if so with what? A topical corticosteroid? Pimecrolimus? Tacrolimus? Oth...

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Clam Digger's Legs

Mike LaCombe, a cardiologist from Maine, has a question for our panel."G.M. is a 48 y.o. clam digger from Maine. These individuals are exposed to avian schistosomiasis, and on a web search, the consequent clam-digger’s itch has been rarely associated with lymphedema.Sorry, I have no pictures. This man has well-documented lymphedema of the lower extremities for six months.All studies negative: CT scans of pelvis, abdomen, chest, ultrasound of leg veins, cardiac echo ruling out any cor pulmonale, and labs showing no evidence of liver disease,...

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Hypopigmentation in an African Child

Katie Ratzan, a third year Dartmouth Medical School student serving as a Schweitzer Fellow at the Schweitzer Hospital in Gabon, Africa, would like help and advice." I would like to ask your help with a six year old girl who presented to our clinic at the Hopital Schweitzer, with her father & aunt. The child has a recent onset of hypopigmentation of the left side of her face & neck. As of six to seven weeks ago, her skin was entirely normal....

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One More Unfortunate...

Gina Kaulukukui is a grief counselor on the island of Kauai, Hawaii. She sent me the following text along with these photographs. Your impressions may help to solve this tragic mystery.“I would like you to review the attached photos and give me your impressions. This 21 y.o woman was found in the water at Tunnels Beach on the north shore of Kauai following a night of partying. She was reportedly in the water about 7-15 minutes when she was pulled...

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Distal Onycholysis

Abstract: 76 yo retired nurse with a 1 year history of nail dystrophy.History: This 76 yo retired registered nurse had distal onycholysis of her right thumb nail a little over a year ago. It eventually "spread" to involve all finger nails. Her medications include lorazepam, citalopram, Premarin and thyroid. All have been taken for many years. She has not used acrylic nails for more than five years. No unusual trauma, but she does use a nail...

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Skin Cancer Observation from Baghdad

Case presentation by:Professor Khalifa Sharquie,Baghdad, IraqI have had the opportunity to see many cases of skin grafting on the face after excision of multiple skin solar keratosis and skin malignancy. Some of these have been in patients with xeroderma pigmentosa (XP). The grafts remained free of actinic disease and have stayed clear for many years, in some cases for more than 20 years. I have never observed them to develop solar damage, solar...

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Erythema Migrans with Pustules

This 27 yo woman was sent from the E.R. with a 5 day history of a solitary 20 cm annular plaque on the right hip. It looks classical for erythema migrans (EM) of Lyme disease. Her three year-old daughter had a tick on her skin 2 weeks ago, but she has no history of tick bite. The patient is well otherwise.Photos taken June 24, 2008Clinically, this is Lyme disease, but no reports in literature of pustules. There is one from China with vesicles...

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Ranula

Abstract: 16 mo girl with mucous cyst of lower lip.HPI: This 16 mo Chinese girl presented for evaluation of a lip lesion that has been present for two months. It waxes and wanes in size. The lesion does not appear to bother her. Her mother speaks little English and is very worried about this lesion.O/E: 6 mm translucent cyst lower lipClincal Photo:Lab/Path: N/ADiagnosis: Mucous Cyst (Ranula)Questions: How would you approach this patient? I...

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Man from Mauritius

Presented by Dr. Philip Li Loong, Quatre Bornes, MauritiusAbstract: 27 year old man with four year history of a papular eruption.HPI: This man's lesions began on the face four years ago and later developed in the groins and axillae. Initially macules, they became papular and much more numerous. At onest, they were felt to be verruca plana. Cryotherapy was tried without success.O/E: The lesions are 2 - 3 mm in diameter brown to yellowish papules....

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Know When to Cut, Know when to Punt

The patient is an 87 yo man with a mild dementia. He lives in an assisted care facility. Has an attentive and caring daughter. In October of 2007 he had a wide-local excision of s large SCC on the left forehead by a general surgeon. Path report showed "clear margins." When seen on May 30, 2008 a 4 x 3 cm recurrence was noted. The picture of the right TMJ area shows a scar from micrographic surgery from a similar lesion the patient had ~ 10...

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Two Foot and One Hand Disease

These are the hands of a 35 year-old plumber I saw recently. He was not aware of a dermatitis of his feet, but inspection showed mild moccasin-type T. pedis on both feet and subtle onychomycosis. KOH prep from the right hand was positive for septate hyaline hyphae. We all see two foot and one hand disease regularly. Do you have any theories as to why only one hand is involved? This is a peculiar dermatologic vignette.Right HandLeft H...

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Penile Pain

The patient is 40 yo heterosexual male in a monogamous relationship for the last 6 years. Neither he nor his partner has a history of having had sex with anyone else ever before.Three months ago he had the onset of pain at the tip of his glans during coitus and experienced pain also on pulling at the tip of his foreskin. A month later he noticed a few grouped "vesicles" at the ventral tip of his glans. These lesions have persisted unchanged. ...

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21 yo man with warty plaque on foot

Presented by Henry Foong, Ipoh, MalaysiaA 21 yr old student presented with 5-year history of warty growth on theright foot. It started as a small lesion which gradually got bigger.Pertinent findings on examination were raised hyperkeratotic plaque 5 x 3 cmon the medial border of the dorsum of the right foot. It has a verrucoussurface with blackish dots. Regional nodes were not palpable.Clinically he has chromoblastomycosis of the right foot.A biopsy...

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No Man is an Island

Thallium poisoning with skin manifestationsPresented by Professor Khalifa SharquieBaghdad, IraqHistory: A few weeks ago, an outbreak of thallium poisoning occurred in Baghdad and all of the patients had positive tests for thallium. We had the opportunity to see cases with skin manifestations. All patients gave a history of eating cakes and presented to hospital with nausea, vomiting followed by mental and peripheral neurological complaints. The...

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