Clinics

An itchy rash on the feet

A 25-year-old man with no remarkable past medical history presents with an itchy rash on the feet. Symptoms began 2 months ago, starting over the dorsal toes with redness, scaling, and itching. The eruption spread over the dorsum of the feet and progressed to weeping and crusting. He reports recently buying new shoes for work…

Fine wrinkles on the neck, chest, axilla, trunk, back, and upper arms

A 55-year-old black man presents for evaluation of fine wrinkles that had developed over the past year. Physical examination reveals diffuse areas offine wrinkling that run parallel to lines of cleavage on his neck, chest, axilla, trunk, back, and upper arms bilaterally. The affected skin has normal pigmentation and lacks erythema, induration, and atrophy. Lateral…

A 3-cm exophytic, mildly tender nodule on an African American man

A 26-year-old African American man with no significant past medical history presents with a growth on his left foot that had been increasing in size for 1 year. He initially thought it was a wart but had concerns when it continued to grow and became painful. Examination reveals an exophytic, brown, and mildly tender nodule,…

Painless, bruise-like hyperpigmentation on a woman with lupus

An African American woman, aged 50 years, presents with painless “bruises” on her leg. She first noticed bruises on both legs a year ago and reports that they have since become larger. Physical examination reveals blue-black macules and patches on both shins. The macules are asymptomatic, and the remainder of the physical examination is within…

Itchy, burning rash that recurs on the legs every winter

A man, aged 68 years, with no known history of atopy presents with a 4-month history of an itchy and burning rash on the legs that has been recurring every winter for the past 3 years. He notes that he had dry skin at baseline and did not use emollients, but he did try hydrocortisone…

Brown macules on the lips and nail changes

An elderly man presents with asymptomatic hyperpigmented, confluent, brown macules on his upper and lower lips, along with hyperpigmented macules on his hands. He also has diffuse blue-black bilateral melanonychia with nail dystrophy on his toenails, and his fingernails contain longitudinal melanonychia with hyperpigmentation of the proximal nail beds. He denies any family history of…

Rashes, diarrhea, and neuropsychiatric issues


A man, aged 42 years, presents with a 6-month history of a painful, scaly skin rash. The eruption is symmetrically distributed over photosensitive areas, affecting his face, neck, upper back, forearms, and hands. The dorsal surfaces of his hands and forearms exhibit a dusky brown coloration over rough and cracked skin. He complains of itching…

Thickening of skin and plaques on a man’s nipples and areolas

A 68-year-old white man presents with 4 weeks of progressively worsening thickening of the skin and plaques on the bilateral nipple and areola. He has no personal or family history of warts or epidermal nevi and has not had hormonal therapy. On examination, he has hyperpigmented, verrucous plaques bilaterally, with no associated erythema or lymphadenopathy.…

Shiny, skin-colored, pinhead-sized grouped papules on a young boy

A 4-year-old white male presents with a 3-month history of an asymptomatic papular rash on his back, abdomen, chest, upper arms, and ankles. His medical and family histories are otherwise unremarkable. On examination, the grouped papules are shiny, monomorphic, skin-colored, and pinhead-sized. The papules exhibit koebnerization but no erythema or tenderness. His nails, hair, oral…

Purple papules in an arcuate pattern on the genitalia

An African-American man, aged 35 years, presents with a 3-month history of pruritic penile lesions. Examination reveals an arcuate pattern of raised violaceous-to-flesh-colored papules with central clearing on the glans penis and a few scattered, raised violaceous-to-flesh-colored polygonal papules of the glans penis and distal penile shaft. Results of the remainder of the skin examination…

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