DermDx

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…

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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…

Derm Dx: Reticulated erythema on the lumbar back

A 36-year-old woman presented for evaluation of a rash on her lower back and bilateral flanks. She has a history of interstitial cystitis and has had more than 15 surgeries. Most recently, she had a nerve stimulator implanted three weeks prior to presentation. The patient reported no complications from the surgery and stated she was…

Derm Dx: A 32-year-old man with multiple itchy, malodorous papules

A 32-year-old man presents with multiple rough, crusted, itchy, malodorous skin papules on the chest, back and forehead.Further examination reveals flat wart-like papules on the dorsa of the feet and hands. The patient’s nails are chipped and have longitudinal ridges. Family history is not available, as the patient was adopted as a child.What’s your diagnosis?Submit…

Derm Dx: Unexplained blisters, primarily on the hands and feet, develop into mild ulcerations and heal without scarring

A child presents with recurrent unexplained blister formation, primarily on the hands and feet that develop into mild ulcerations and heal without scarring. Smaller erosions and vesicles are present on the elbows, arms and shoulders, and the patient has lost several fingernails and toenails. Family history is negative for psoriasis and atopy. What’s your diagnosis?…

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