Clinics

Spreading eczema and areas of raw, oozing skin

A 13-month-old toddler with spreading eczema on his trunk and arms is brought in by his mother. She is applying moisturizer and a cortisone cream. However, 2 days earlier, a wound appeared on his left hand that appears to be infected. Since then, more areas of raw, oozing skin have developed. Examination reveals lichenified scaling…

A facial mass with “bag-of-worms” appearance

A 30-year-old healthy Hispanic woman presents with a slowly progressive facial deformity present since early childhood. She denies any new lesions during this time, any history of trauma to the area, and any family history of similar skin lesions. Examination reveals a bulging, deformed dermal mass with a “bag-of-worms” appearance involving the upper right quadrant…

A rash on a woman who rides horses in the winter

A 32-year-old white woman who has never smoked presents with pruritic, tender, erythematous, violaceous patches with eczema-like blisters on her upper, lateral thighs. In 2012, she began traveling annually from Pennsylvania to South Carolina, from January through April, where she works with and rides horses daily from morning to evening. Her symptoms began in her…

A fluid-filled papule at the corner of the eye

A healthy 45-year-old woman presents with a several-month history of a small papule at the corner of her right eye. The lesion is asymptomatic and is not enlarging, but she has cosmetic concerns. She denies diplopia, vision loss, or any other lesions on her face and body. Examination reveals a dome-shaped, smooth, translucent papule filled…

An asymptomatic, fleshy tumor on the base of the toe

A healthy 30-year-old man presents with a 3-year history of an asymptomatic, fleshy papule at the base of his great toe. He denies any new lesions during this time, a history of trauma to the area, or a family history of similar skin lesions. He was treated previously by another dermatologist with cryotherapy; however, he…

A woman with diabetes and a sore on her leg

A 45-year-old woman with insulin-dependent diabetes mellitus presents with a sore on her right leg. She describes a long-standing history of asymptomatic lesions on her shins but had only recently injured her leg, causing the sore, which is slow to heal. Despite a 15-year history of diabetes, she has no systemic complications. She has large,…

Rapidly extending lesions originating in the perianal area

A 60-year-old man presents with rapidly growing lesions on his face, trunk, axillae, flexural areas, and groin. The lesions appeared 3 months earlier in his perianal area and extended rapidly to other areas. Previously, he was treated with topical agents for atopic dermatitis and seborrheic dermatitis without improvement. Examination reveals disseminated violaceous papules and plaques…

Two well-defined 6-mm nodules on a teenager’s arm

A 13-year-old girl presents with a cystic lesion that has been on her forearm for several years. Concerned about the lesion, she reports that it may have grown slightly larger in the past year and it is intermittently painful. More recently, a second similar lesion has appeared in close proximity. She denies any other suspicious…

Bilateral periorbital yellow-brown plaques

A 62-year-old man with well-controlled rosacea, a monoclonal gammopathy of undetermined significance, and chronic lymphocytic leukemia (CLL; stable on no current therapy) was seen in the clinic for a full-body skin check. Results of his examination were unremarkable except for the presence of periorbital, yellow-brown plaques with violaceous borders involving the upper and lower eyelids,…

Six tan patches on a healthy teen

A healthy 16-year-old girl presents with six tan patches on her trunk and upper arms, freckles in her axillae, and a reddish discoloration under the tip of her thumbnail. The tan patches have been present since birth but have enlarged over the past 4 years. She reports paroxysmal pain and cold sensitivity involving the discolored…

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