Clinics

Multiple, comedo-like openings filled with keratin plugs

A healthy 15-year-old girl presents with a solitary, asymptomatic lesion on her back. The lesion has been present since birth but has enlarged over the past 2 years. She denies association with previous trauma and irritation. Examination reveals multiple, comedo-like openings filled with dark lamellate keratinocyte plugs grouped in a linear distribution over a slightly…

A pink papule that grew from 1 mm to 10 mm in a week

A 28-year-old healthy white woman with no significant past medical history presents with an enlarging papule on her right lateral neck. She describes a 1- to 2-mm pink papule that grew to approximately 10 mm within the past week. With minimal rubbing or trauma, the papule intermittently bleeds. It is otherwise nontender and nonpruritic. She…

An asymptomatic lesion with positive Darier sign on an infant

A healthy 12-month-old infant girl presents with a yellowish-orange papule on the right upper extremity. Her mother first noticed this lesion approximately 6 months earlier. It has never bled, ulcerated, or formed blisters. The infant does not scratch the lesion nor appears otherwise bothered by it. However, when the lesion is rubbed, it appears to…

Green discoloration of a dishwasher’s fingernail

An otherwise healthy 60-year-old dishwasher presents with asymptomatic green discoloration of his right middle fingernail over a period of 2 months. The discoloration began from the distal margin. He denies wearing gloves while working and reports a tendency to pick at his nails when nervous. On examination, distal onycholysis and green discoloration are present exclusively…

Retiform purpura with necrosis and bullae

A 50-year-old woman presents with a 5-day history of progressive, painful rash involving her face, trunk, extremities, nasal tip, and ears, in addition to fever and arthralgia. She admits to a history of polysubstance use and states that her last use was a week prior to symptom onset. She denies a history of autoimmune disease…

Pink patches on the hip and buttock

A 43-year-old elementary school teacher presents with a rash that began on his left thigh approximately 4 months earlier; the rash has since spread. It is mildly itchy but has no associated pain or bleeding. His past medical history is significant for allergic rhinitis and atopic dermatitis. Suspecting eczema, he has been applying an over-the-counter…

Plaques and erosions around orifices and acral regions in an infant

A 7-month-old male who had been born prematurely presents with a 2-month history of diarrhea, failure to thrive, alopecia, and rash involving the perioral, perianal, and acral areas. He had been treated unsuccessfully for presumed atopic dermatitis with topical corticosteroids. He was exclusively breastfed until 2 months ago, when he was transitioned to formula. Examination…

A mobile subcutaneous nodule near the eyebrow

A 64-year-old woman presents with a 6-month history of a slowly enlarging bump near her left eyebrow. The patient says it appeared suddenly and became a nuisance, as well as cosmetically unacceptable as it enlarged. She denies any pain, tenderness, or oozing, and denies any other similar lesions elsewhere. Her pertinent dermatologic medical and family…

Hypotrichosis in a woman and her infant son

A 30-year-old Hispanic woman presents with her 1-year-old son, concerned that he has only small amounts of thin, wispy hair on his head and has none anywhere else on his body. She notes that he does not yet have any teeth, but has a large forehead and ears. He has been irritable and crying for…

Deformity of the breast in a premenopausal woman

A 48-year-old premenopausal woman, who has had one pregnancy and has delivered once, presents with a 15-month history of left breast deformity. The patient began having pain in the region 2 months ago. A review of systems is negative for weight loss, fever, or nipple discharge. Her medical history is otherwise unremarkable, and her family…

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