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Clinical Quiz

Mildly pruritic elbow and knee plaques

A girl aged 12 years presented with a six-month history of enlarging red plaques on bilateral elbows and knees. She was otherwise healthy and had no history of recent infections. The lesions were associated with mild pruritus, which was not keeping her up at night. There was no family history of atopic dermatitis, allergic rhinitis,…

Hyperpigmented lesion returns to the palm

A woman aged 37 years presented with an asymptomatic, ill-defined patch on the palm. The hyperpigmented, bluish-gray lesion had flared on and off for the past few years. Occasionally, the patch would fade considerably, only to darken several times a year, never quite disappearing completely. Two potential triggers emerged on history-taking: (1) an OTC aspirin-…

African-American Woman with Urinary Frequency, Bladder Discomfort

A 28-year-old African-American woman presented with complaints of urinary frequency and bladder discomfort. She was found to have renal failure (creatinine [Cr] 4.1) and a urine culture was positive for Escherichia coli. She was treated with a full course of antibiotics but renal failure persisted. Medications included occasional nonsteroidals for headache and albuterol for asthma.…

Derm Dx: Clusters of smooth, pearly umbilicated papules in a 4-year old

An otherwise healthy 4-year-old girl presents with clusters of smooth, pearly, umbilicated papules 2-to-6 mm in diameter. The rash first appeared as groups of waxy, skin-colored papules on the girl’s arm, but soon spread to her torso, axilla, face and eyes and became inflamed and itchy. The girl is enrolled in swimming lessons at the…

Persistent rash not affected by steroids

A boy aged 10 years presented for treatment of “eczema” of three years’ duration on his back and legs. The rash was neither itchy nor painful. The boy’s pediatrician and allergist prescribed various topical medications that helped only temporarily. Most recently, he used a cream containing clotrimazole and betamethasone with very little improvement noted. Medical…

Asymptomatic ulcer in a high-risk patient

A man aged 52 years man presented with a one-week history of an isolated sore on his upper lip. He reported no recent trauma or antecedent blistering or burning. However, he did admit to a highly risky sex life, boasting about the diversity of his partners. The man brought documentation of negative HIV and syphilis…

Derm Dx: Symmetrical brown hypermelanosis on the cheeks, forehead, nose and chin

A 25-year-old Hispanic woman presents to the dermatology clinic in the spring with a symmetrical brown hypermelanosis on the cheeks, forehead, nose and chin. The macular lesions have serrated, irregular and geographic borders. History reveals no other symptoms, but the patient reports spending time outside gardening. What’s your diagnosis? Submit your answer and read the…

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