DermDx

Derm Dx: Large brown patch that was present at birth

A 6-month-old boy is brought in for a routine dermatology checkup. He was born with a large brown patch covering most of his right thigh. Some areas of the patch have excessive hair. The patient is otherwise healthy, and there is no family history of skin diseases or skin cancers. Mom is asking if her…

Derm Dx: Pruritic papules in a healthy 42-year-old woman

A 42-year-old Hispanic woman with no prior medical problems presents complaining of multiple pruritic papules and hyperpigmented spots on her arms, trunk and legs.The patient states that the pruritis is frequently worse at night, at times unbearable, but at other times the skin lesions are completely asymptomatic. On physical exam the patient has multiple firm,…

Derm Dx: Multiple spreading skin lesions in a Vietnam War veteran

A 67-year-old man presented with complaints of pain and discomfort associated with multiple spreading skin lesions and enlarging lymph nodes. He also noted a 10-kg weight loss and fatigue. There was no previous medical or surgical history. The patient had no known drug allergies and was not taking any medications. However, he had been exposed…

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Derm Dx: A rash response to southern exposure

A 28-year-old Hispanic man presented with a 10-month history of a pruritic rash on his right flank (Fig 1). One to two weeks prior to noticing the lesion, he had spent five days in Arizona. The lesion had doubled in size in one month, according to the patient. He had no history of similar rashes…

Derm Dx: Anogenital ulcerations in a female with HIV/AIDS

A 23-year-old female presents to the ED with a 6-month history of exquisitely painful genital ulcers. The patient reports that she initially developed a small white pustule that broke and then formed ulcers around her labia minora. She continued to have multiple ulcers around her genital region that would heal and reappear. During the past…

Derm Dx: Black discoloration of the hands

A 75-year-old man presented to the dermatology clinic for treatment of multiple actinic keratoses and evaluation of a black discoloration of his right hand and fingers. For the past 12 to 14 years, since retiring, the patient had peeled apples for pies several times each year. While doing so, he would develop black discoloration on…

Figure 1

Derm Dx: Fine, dry scales on the trunk and extremities

An 11-year-old girl presented to the dermatology clinic complaining of “dry skin” on her shins. The condition had been present since early childhood, but its appearance had not bothered the girl until recently. Physical examination revealed fine, dry, “pasted-on” scales and follicular plugging (Figure 1) on much of her trunk and extremities. The lesions were…

Derm Dx: Blisters, blotches and burning in a 42-year-old woman

A 42-year-old woman with herpes simplex virus (HSV) 1 presented with a five-year history of monthly recurring oozing plaques and blisters on her face, hands and forearms.The eruption was preceded by a burning sensation, and the lesions always appeared at the same locations. A similar eruption had occurred 12 years earlier but abated after a…

Derm Dx: Pruritic rashes that run in the family

A 54-year-old woman presented with a 26-year history of intermittent, malodorous, pruritic skin lesions. Several of her relatives have experienced similar rashes. Past treatments have included oral prednisone, topical steroids, chronic oral doxycycline, and short courses of amoxicillin, cephalexin and cefuroxime, all of which temporarily improved the condition. Physical examination revealed erythematous eroded scaly papules…

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