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A painless, non-itchy rash

A 53-year-old woman presents with a rash on her left lower extremity that has been present for several weeks. The patient is a native of Brazil and immigrated to the United States in the past month. She states that the rash is painless and does not itch. On examination, the patient has multiple, raised, hyperpigmented…

Papules on the soles of the feet

A 6-month-old infant presents with 2 weeks duration of erythematous papules on the soles of both feet and in the toe web spaces. On examination, a single burrow is visible on the left sole. Multiple family members also complain of a pruritic rash that has been bothering them for several months. The family members have…

Headache, malaise, and a rash

A 42-year-old man presents with a four-day history of experiencing headache, malaise, and stabbing right-sided headache. Two days after his initial symptoms appeared, he developed a rash over the area of pain. He reports that he went hiking through the Texas hill country prior to becoming ill. The patient is otherwise in good health and…

Fingernail dystrophy in a young child

The patient is a 12-year-old Hispanic girl who presents with a 6-month history of nail dystrophy involving all of her fingernails. On examination, all 10 of her fingernails exhibit longitudinal ridging, pitting, fragility, thinning, and distal notching. The patient’s mother is very concerned about the cosmesis of her daughter’s nails. The patient has no systemic…

A yellow-orange hairless patch on a 1-year-old

A 1-year-old boy presents with a single, L-shaped, yellow-orange hairless patch over the left preauricular skin. The patient’s mother notes that he has never grown hair in that location. The mother is concerned because the area used to be smooth, but seems to be changing. The patient has a history of prematurity and low birthweight…

Fragile, bullous lesions on the trunk of a child

An 8-year-old African-American boy presents with a 3-day history of fever, pain, and a rash on his trunk. On examination, the patient has several fragile, bullous lesions on his trunk, many of which have eroded, exposing erythematous, annular lesions. The patient is febrile and shaking in the office, and he appears to be in pain.…

Red bumps on the fingers

A 13-year-old boy presents to the dermatology clinic concerned about the development of red, itchy, and sometimes painful bumps on his fingers. He first noted seeing the lesions 2 months prior, in early December. Although the initial lesions have since resolved, new lesions appeared after a skiing trip the previous weekend. The patient is otherwise…

A pruritic rash and rippled plaques on a woman’s shin

A 52-year-old Hispanic woman presents with a 3-year history of a very pruritic rash over her shins bilaterally. On examination, both shins are covered in hyperpigmented papules that have coalesced to form thin, rippled plaques. The patient is very concerned about the appearance of her legs and the intense pruritus in the areas of the…

A dark lesion on the finger

The patient is a 13-year-old adolescent girl who presents with a 1-month history of a dark lesion on her finger. She states that the lesion does not bother her, but she came to the clinician because her mother was very concerned about the enlarging area of hyperpigmentation. The patient has no past medical history, no…

An intensely itchy rash on the abdomen

A 72-year-old man presents to the clinic with an intensely itchy rash on his abdomen and chest that appeared 2 months prior. He denies starting any new medications prior to the onset of the eruption and any systemic symptoms. Although he traveled and stayed in hotels recently, he reports that his wife does not exhibit…

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