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Recurrent C difficile requires pulse vancomycin therapy; fecal microbiota transplant shows promise.

Clostridium difficile: New Guidelines Confront Hypervirulent Strain

A 64-year-old woman with a history of basal cell carcinoma presents to the dermatologist for skin cancer surveillance. She is incidentally noted to have bruising on her upper eyelids (above). On questioning, she reports experiencing recurrent intermittent eyelid bruising for several years. She denies a history of trauma to her face, pain, or other associated symptoms.

Her medical history is significant for hyperlipidemia, hepatitis C (diagnosed >30 years earlier), osteoporosis, celiac disease, and idiopathic proteinuria for several years. Her surgical history includes appendectomy and carpal tunnel repair.

Pertinent family history includes her mother dying of multiple myeloma and her father of complications of diabetes.

Review of systems is significant for vague symptoms of gastrointestinal discomfort. On more directed questioning, she reports the eyelid purpura is temporally related to the Valsalva maneuver/ strained bowel movements. Her medications include atorvastatin, risedronate sodium, a daily multivitamin, calcium, vitamin D, and aspirin.

Her examination reveals no bruising elsewhere and no findings of interest on skin or mucous membranes.

B. Allergic contact dermatitis, purpuric type

Eyelid bruising was observed on a 64-year-old woman during routine skin cancer follow-up. She denied trauma or pain. What does this look like to you? 

Image IQ: Recurrent Eyelid Purpura 

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

Clinical Topics

What's This "Red Spot"?

 year-end video series we feature interviews with leading physician scientists and principal investigators who discuss the most important clinical trials of the year with experimental drugs, devices, and procedures, the implications of findings for daily primary care practice, and the promise of these unique additions to patient care. 

Expert Perspectives 2024: The Dynamic Future of Obesity Medicine, with Donna Ryan, MD

Welcome to Expert Perspectives 2024: Interviews with Key Opinion Leaders on Novel Therapeutics

In the interview series that begins with the video above, Donna Ryan, MD, professor emerita at the Pennington Biomedical Research Center in Baton Rouge, LA, discusses groundbreaking 

from 2024 and what is to come in 2025. In this first video,

 Pivotal Obesity Trials in 2024: A Conversation with Donna Ryan, MD

 (above), Ryan highlights pivotal trials that showed how GLP-1 receptor agonists (ie, 

) are redefining obesity treatment by addressing chronic disease management.

Following are links to the rest of the series:

The Evolving Perception and Utilization of Antiobesity Drugs: Expert Discussion

Emerging Obesity Research to Watch For in 2025

Future of Obesity Care: 3 Wishes from Thought Leader Donna Ryan, MD

The future of obesity medicine is filled with promise as GLP-1 RAs and other peptides continue to demonstrate pluripotency in metabolic disease.  

A 32-year-old woman presents with recurrent episodes of lip swelling associated with massive, painful blister formation and crusting.

A 32-year-old woman presents with recurrent episodes of lip swelling associated with massive, painful blister formation and crusting. What is this?

Perioral Blistering and Crusting

10 More Can't Miss Doctor Gifts Worth Giving...or Having

Even if you discovered the ultimate gift in

An MDF stethoscope with leopard print tubing? A digital highlighter/scanner that translates and talks back? Check out these and 8 more uncommon gifts for health care professionals. 

Christina M. Surawicz, MD

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