Heart Failure

Cardiovascular Clinical Consult

Adult Immunization

Hepatic Disease 

Behcet’s Disease

Rare Disorders

Pediatric Immunization

Implementing The Topcon Ocular Telehealth Platform

Weight Management

Screening

Monkeypox

Guidelines

Men's Health

Panic Disorder  

Anxiety

Eating Disorders

Depression

Substance-related Disorders

ADHD

Psychiatry 

Seasonal Allergies

Allergy

Nutrition 

Pregnancy and Birth

Women's Health

Atrial Fibrillation

Cholesterol Disorders

Cardiovascular Disease

Hypertension

Cardiology

Substance Use

Child/Adolescent

Pediatrics

Kidney Disease

Genetics

Medical Cannabis

Complimentary & Alternative Medicine

Skin Diseases

Dermatology

Thyroid Disorders 

Diabetes

Diabetes Type 2

Insulin

Endocrinology 

Oral Medicine 

Otorhinolaryngologic Diseases

Fibromyalgia

Pain

Irritable Bowel Syndrome 

Inflammatory Bowel Disease

Gastrointestinal Disorders

Geriatrics

Coronavirus

Hepatitis C

Cold, Cough, and Flu

Bacterial Conjunctivitis

Immunization

Influenza

HIV AIDS

Sexually Transmitted Diseases

Infection

Osteoporosis

Imaging 

Musculoskeletal Disorders  

Obesity

Rheumatoid Arthritis

Arthritis

Gout

Rheumatology

Technology

Colorectal Cancer

Kidney Cancer

Lung Cancer

Melanoma

Skin cancer

Prostate Cancer

Breast Cancer

Cervical Cancer

Cancer

Nephrology

Anemia

Dementia

Epilepsy

Cerebrovascular Diseases

Headache and Migraine

Parkinson Disease

Alzheimer disease

Stroke

Mental Health

Headache

Migraine

Nervous System Diseases

Sleep Disorders

Neurology

Asthma

Cystic Fibrosis

COPD

Pneumonia

Respiratory Diseases

Pulmonology

News

All News

Office Procedures

Practice Management

Media

Around the Practice

Between the Lines

ConsultantLive

Expert Interviews

Institutional Insights

Medical World News

Podcasts

Primary View

Provider Toolkits

Readout360

Conferences

Conference Coverage

Conference Listing

Resources

Image IQ

Interactive Posters

Polls

Publications

Quizzes

Subscribe

CE/CME

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Information

Patient Care Online

Facebook

LinkedIn

Clinical Focus

Allergy & Immunology

Endocrinology

Gastroenterology

Infectious Disease

Men’s Health

Pain Management

Psychiatry

Women’s Health

Business Focus

Billing and Collections

Career Planning

Coding and Documentation

Concierge Medicine

Cybersecurity

EHRs

Investing

Patient Relations

Personal Finance

Remote Patient Monitoring

Staffing

Telehealth

Value-based Care

Spotlight

Unmet Needs in Managing MDD

Interpreting Thyroid Function Tests

Using Thyroid Lab Tests

Testing & Screening to Optimize Men's Health

1rem

Authors

Patients almost always believe that their anorectal problems are caused by hemorrhoids, regardless of the nature of their symptoms. They are often dismayed when we insist that they must come to the office for an examination before we can prescribe any treatment.

Anal Pain: Office Diagnosis and Treatment

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Clinical Topics

Rash Around the Mouth of a 5-year-old Child

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months.

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months. Your diagnosis?

“Swimsuit Area” Rash: Your Dx?


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

This 15-year-old has a pruritic, flat-topped, monomorphic papular rash on his face and arms for the past 6 days. He takes no medications, has not been sick recently, and has not been exposed to poison oak.

A.  Papular acrodermatitis of childhood (Gianotti-Crosti)

This monomorphic papular rash is unrelated to medications, recent sickness, or exposure to poison oak. It developed about 6 days earlier. 

Teen With Itchy Papular Rash on Face and Arms

A 54-year-old woman with a history of chronic pancreatitis secondary to alcohol abuse presents to your office with a chief complaint of diarrhea, weight loss, and foul-smelling, oily stools. After an appropriate workup, you diagnose her with exocrine pancreatic insufficiency and initiate pancreatic enzyme replacement therapy. She responds well to the medication and her diarrhea resolves and she begins to regain the weight she lost.

She returns 6 months later  with a complaint of return of oily stools and diarrhea, this time associated with significant bloating. She says she has strictly adhered to the enzyme replacement regimen.

A. Repeat 72-hour stool fat quantification

C. Magnetic resonance cholangiopancreatography (MRCP) 

These symptoms are recurrent despite patient's adherence to enzyme replacement therapy for pancreatitis. Your next step?

What Cause of Bloating, Oily Stool, and Diarrhea? 

Michael E. Friscia, MD

Articles

Latest Updated Articles