Clinics

A pruritic rash in the interscapular area

The patient is a 38-year-old Hispanic woman who presents with a 1-year history of a very pruritic rash over her interscapular area. On examination, she has a circular area of slightly hyperpigmented macules in the interscapular region. The patient complains of pruritus but no pain in the area of the rash. The patient has no…

A worsening rash with a malodor

The patient is a 19-year-old woman who presents with several years of a worsening rash. The rash appears as erythematous, hyperkeratotic thin plaques in a seborrheic distribution. The patient states that the rash is very irritating and sometimes pruritic. The patient’s main complaint is that the rash exudes a malodor. The patient states that her…

A rash of the axillae that develops and involutes spontaneously

A 35-year-old woman is referred for evaluation and management of a rash involving both axillae. She reports recurring episodes of the same rash beginning in her early 20s. Lesions develop and involute spontaneously. Areas affected included the axillae, neck, and groin. Historically, outbreaks are more common and worse during the summer, and after vigorous exercise.…

A baby with blisters on the palmar and plantar surfaces

On day-of-life 2, a 3-day-old boy who was born with no visible skin problems begins to develop erosions and bullae over both the palmar and plantar surfaces. These bullae are localized to areas of friction or trauma (eg, where electrocardiogram leads were placed). The mother’s pregnancy was normal, and the infant had been born without…

An unusual scrotal plaque and a history of nonmelanoma skin cancer

A 79-year-old white man with an extensive history of nonmelanoma skin cancer presents for a routine skin examination. During his visit, he asks to have a groin rash checked. For 1 to 2 years, he has been using over-the-counter and prescription antifungal and antibiotic creams for a presumed “jock itch.” Recently, he has developed more…

A postmenopausal woman with a white discoloration on her breast

A 61-year-old woman presents concerned about a white discoloration on her left breast that she first noticed 6 months earlier. It itches at times, and she is worried it might be cancerous. She showed it to her gynecologist at her annual visit, and he referred her to the dermatology clinic. Physical examination of the left…

Diffuse rash in a man with paraproteinemia

A 56-year-old man presents with diffuse pruritic papules involving the upper body, with nose and forehead thickening. Over the past 2 years, he has been evaluated by multiple specialists for dysphagia, reflux, chronic kidney disease, hypertension, and dyspnea on exertion. Examination results are significant for generalized firm, fleshy, dome-shaped papules of several millimeters in diameter,…

An extremely itchy rash on the arms following yardwork

A 34-year-old man presents with an itchy rash, primarily on his arms, but also, to a lesser extent, on his face. He denies any fever or malaise, and his medical history is unremarkable. He does not take any medications and notes that he spent the previous weekend doing yardwork on his property, and the rash…

Painful diamond-shaped tongue lesion in elderly man

A 62-year-old white man with a past medical history of latent tuberculosis, vitiligo, and psoriasis presents for follow-up for treatment of psoriasis. The patient’s psoriasis has proven refractory to numerous treatments over the years, so he began treatment with secukinumab, a monoclonal antibody against interleukin-17A. After 2 months of therapy, the patient reports new-onset tongue…

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