Follicular Mucinosis?

Abstract: 27 yo woman with 6 month history of plaques faceHPI: This 27 year-old baker has asymptomatic plaques on the right cheek for six months. She has not been treated as yet.O/E: Two ill-defined plaques on right cheek. There is a suggestion that follicular openings are dilated.Clinical Photos:One can compare the right and left cheeks. Dermoscopic image as well.Normal left cheek on left, affected right cheek on right.The image to the right...

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Acneiform Eruption in an 11 year-old boy

Abstract: 11 y.o. boy with localized papular dermatitis of faceHPI: This 11 yo boy has a 2 month history of a facial eruption. Initially, his mother applied Bacitracin ointment. It was not effective and they then used a prescription "hydrocortisone" ointment for a few weeks which was similarly unhelpful. Good general health. He takes Adderal for ADHD.O/E: There are erythematous acneiform papules around the right alar groove. Face is otherwise...

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Does this ring a bell?

HPI: The patient is a 36 yo woman on home hemodialysis after a failed renal transplant for membraneous glomerulonephtritis who was referred by her rheumatologist for a "stat" skin biopsy. She sees the rheumatologist for amyloid nephropathy.Shs is having the second episode of a painful erythematous eruption on the dorsum of the left foot. The first episode, two months ago, resolved after two weeks of Keflex and Bactrim.Meds: Oxycontin, prednisone...

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Post-Bypass Dermatitis

Presented by Professor Khalifa SharquieBaghdad, IraqHPI: A 58 year old patient developed sudden heart infarction that needed urgent bypass heart surgery in March of 2009. Left saphenous vein was used as graft. The patient was otherwise healthy apart from developed a rash on the left leg along the incision scar. The rash is nonpruritic and red in color ranging in size from pinpoint to 2 cm in diameter. This gradually enlarges in size and stop, then...

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Atypical plaque on the hand

Submitted by Dr Henry Foong, Ipoh, MalaysiaAn 80-year-old retired goldsmith presented with 4-month history of an ulcerated plaque on the left hand. It had gradually increased in size. His past medical history included hypertension, diabetes mellitus, and ischemic heart disease. His medications included norvasc, zocor, ticlid and amaryl.Examination of the skin showed a localized ulcerated verrucous plaque 6 x 6 cm on the dorsum of the left hand. Closer...

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Annals of Puzzling Purpuras

Percussion Purpura -- Taiko PurpuraSubmitted by Trudi Shim, San Antonio, TexasHistory: The patient is a 63 year-old Japanese-Hawaiian woman who plays Taiko drums as a hobby. She has a past history of porphyria cutanea tarda (PCT) from estrogens which is now quiescent. A few years back, she developed tendonitis of her wrists and received cortisone injections near each wrist from two different physicians. When she developed a hypopigmented patch...

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Parastomal Ulceration

Presented by Amanda Oakley, Hamilton, NZThe patient is a 44 year old man with parastomal ulceration over the last 12 months.He had a stable stoma for 12 years, following colostomy to remove rectal tumour (carcinoid) and is healthy otherwise with no bowel problems and no skin disease elsewhere.Last year he received IV antibiotics for peristomal cellulitis, with complete recovery. A month or so later the peristomal skin began ulcerating. Partial healing...

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Localized Bullae

This healthy 83 year-old man has had a one year history of bullae and vesicles on the medial aspect of the left knee. They come and go. He is on no new medications and does not take any drugss on an as necessary or intermittent basis. His medications consist of valsartan (Diovan), simvastatin and omeprazole (Prilosec).O/E: A collection of vesicles and bullae left knee.Clinical Photo:Lab and Path:Bacterial Culture 8/14/o9 NegativeBiopsies were...

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Tan Papules in a Child

Abstract: Eight year old boy with six month hx of tan maculesHPI: This otherwise healthy boy has had a six-month history of asymptomatic tan macules on his torso. Takes no meds by mouth and is asymptomatic.O/E: Six - eight smooth surfaced tan macules measuring from 5 mm to 15 mm in diameter on torso. After lesions are rubbed they urticate mildly and are faint pink. Dermographia is negative.Photos:Pathology:Diagnos...

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Photodermatitis in a Teenage Girl

Abstract: 8 yr history of photodermatitis in a 17 yo girlHPI: This 17 yo student has an 8 year history of a summer eruption. She has a pruritic eruption of her hands and distal forearms starting in spring and lasting till late fall. In winter her skin is perfectly normal. She has used triamcinalone 0.1% ointment without relief and similarly has not been helped with sunscreens.O/E: Mild lichenification and a fine micro-papular eruption on the...

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Recurrent Toxic Erythema vx. Cellulitis

H.P.I. The patient is a 70 yo woman who has had ~ 10 episodes of a cellulitis-like picture of her legs over the past ten years. She has never had fever or constitutional signs. The process can affect one or both lower extremities. I saw her in 2001 for this and then she was referred by the emergency room yesterday with the same picture. It began with a fall two days ago. She hit her hip -- was in pain and took ibuprofen before this episode....

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Unusual Pigmentation of Legs

The patient is a healthy 51 yo woman with a 5 - 6 year history of asymptomatic progressive hyperpigmentation of the legs. She is in good general health and takes no medications by mouth. The process started on the calves and has spread proximally to the knees. She has rosacea in addition. She thinks her father has a similar problem.O/E: Both legs from just above the ankles to the knees show punctate hyperpigmentation. The skin here has a slightly...

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Amytrophic (?) Dermatomyositis

Presented by Henry FoongIpoh, MalaysiaHPI: A 82 yr old housewife presented with 6 month history of skin eruptions on her face, neck and hands. They were aggravated with exposure to sun. She was diagnosed with carcinoma of the stomach in 2007 and completed chemotherapy about 3 months ago. While on chemotherapy she noticed weakness in getting up and putting on her shirt. She has improved since then. She has a history of diabetes mellitus, and...

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Lyme Tick

This 60 yo man came in for a skin cancer check. He had a basal cell removed from his forehead two years ago. The exam was negative until I checked his leg and noted a funny looking lesion. On closer examination, I realized it was a tick. It's head was embedded in the patient's leg. I removed the tick and gave the patient 200 mg. of doxycycline. This latter might be unnecessary, but a study published in the NEJM gives support to this fairly...

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Abdominal Sinuses in a 23 yo Man

Three month history of draining sinuses lower abdomen.HPI: This college student developed abdominal pain and bloody diarrhea in August of 2008. A diagnosis of ulcerative colitis was made and a number of theapies were tried (including prednisone and Remicaid). All were ineffective and he had a subtotal colectomy and ileostomy performed in December of 2008. Subsequent to that he continues to have some pain in the rectal stump and is scheduled for...

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Trichoepithelioma

A Dermatologic Vignette.The patient is a 78 yo woman with a few year history of an enlarging lesion on the nasal tip. Excellent health.Eight mm in diameter pearly papule nasal tip. Clinically and dermoscopically BCC.Pathology shows this to be a trichoeoithelioma:Question: Observe, refer to Mohs, radiate?Would surgery be deforming in this site? vs. Is radiotherapy overkill?Reference: There are very few references which address this type of lesion,...

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Dissecting Cellulitis of the Scalp

Abstract: 18 yo man with three year history of cystic lesions scalp, axillae, chinHPI: This 18 year-old man has had dissecting cellulitis of the scalp for three years. He has been treated with doxycycline 100 mg b.i.d. and excisions of cysts and sinuses by a plastic surgeon. He presented in May of 2009 for another opinion. He has had a few cysts of the axillae and chin. The patient has observed that his scalp is worse after wearing a helmet...

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Teledermatology Rules: Vasculitis

Abstract: 2o yo man with one week history of palpable purpura.HPI: This 20 yo college student was started on isotretinoin for severe cystic acne a month before he developed a rash on his legs. He also had an upper respiratory infection two weeks before the eruption began. He is away at school (a two hour drive). His mother called the office and spoke to my secretary. Busy week. When I heard that he had a rash, I relayed the message that it...

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