Cheilitis Oscura

Abstract:  59 yo woman with eight month history of cheilitis.HPI: The patient is a 59 yo woman with an eight month history of a pruritic dermatitis which began on the upper lip. It spread to the lower lip and recently to some fingers. For dental hygiene, she has used Crest toothpaste, a white ceramic nasal irrigator, dental floss, a WaterPic and a Sonic Dental Care apparatus on a daily basis.  She has changed this protocol somewhat over...

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Plexiform Neurofibroma

The patient is a 33 yo man seen for evaluation of a large tumor involving the left thigh.  He lives in a rural area and his last medical visit was at age sixteen.  Sadly, he was without medical insurance until recently.  He lived with his father until recently when the latter died, and now he has been taken in by a family in his community.The examination showed a pleasant man with a sunny disposition and a broad smile.  While...

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Dermoscopy Rocks

Presented by Hamish Dunwoodie, MBBSLocum Tenens Physician,Dakota First Nation, Portage La Prairie, Manitoba Overview:  The patient is an otherwise healthy artist from Moncton, New Brunswick who is studying native pottery production with a First Nation's band in Manitoba.  She presented to our clinic with a one week history of a black macule on the left thenar eminence.  The patient has a past history of nonmelanoma skin cancer and...

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Imiquimod and Keloids

The patient is a 42 yo man who had a cyst I&D's on his mid-back four years ago. Postoperatively,  a keloidal scar developed.  It is very painful and pruritic.  He has had intralesional triamcinalone acetonide 40 mg/cc without much effect. The lesion measures almost 4 cm in diameter, but, being sessile, the base is only ~ 2 cm wide.Plan and Question:  We propose to shave this off and use imiquimod post-operatively as has been...

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54 yo man with necrotizing vasculitis

Abstract: A 54 year old man presents with long-standing rosacea and a few week history of mildly pruritic papules on his thighs.HPI: The patient is otherwise well and has been treated with doxycycline for greater than five years for severe rosacea. Recently, it has not been effective. He presented for alternative therapy; and at the time of the visit he mentioned an a pruritic papular eruption of his thighs for two to three weeks. He has had...

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Cutting

Once or twice a month, I see patients with distinctive scars, mostly, but not always, confined to their arms. A recent patient prompted this post. The photo and text are presented with her approval as she feels her story needs to be told.The patient is a 66 year old insulin dependent diabetic who presented with a dermatitis of the abdomen. It had non-specific features and was KOH negative. Most likely a xerotic eczema or an irritant contact dermatitis....

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