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When is it time to refer your patient with low back pain to a specialist for possible spine surgery? How long should you give conservative measures a try? What symptoms signal the need for urgent care? In this video, Raymond Haroun, MD addresses these and other pressing questions.

Low Back Pain: Tips From an Expert on Treatment

Raymond Haroun, MD, works through the evaluation of low back pain and radiculopathy.

Low Back Pain: Tips From an Expert on the Evaluation

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?

Clinical Topics

“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?

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? 

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

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? 

Raymond Haroun, MD

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