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1rem

Authors

There are lots of products in development for weight loss and to treat other metabolic diseases which means more options for more people. 

The GLP-1RA Pipeline is Full - Here's What to Expect

Nearly half of patients who undergo ileal pouch-anal anastomosis develop pouchitis within 2 years post-surgery; up to 80% will develop it eventually. 

AGA News: First Clinical Guideline Published for Treating Pouchitis 

A 50-year-old woman presented with this ulcerative lesion which she said began approximately one month ago as a small “boil” in the center of the now-enlarged area. She squeezed the initial lesion and treated it with topical antibiotic ointment. The lesion progressively expanded and became extremely painful.

B. Cutaneous manifestation of systemic lupus erythematosus

The rapidly expanding lesion began as a small boil in the center of the ulcerated area 4 weeks ago. What underlying process do you suspect? 

Clinical Topics

Ulcer with an Undermined Edge 

10 Essential Vaccination Updates for Primary Care: Winter 2024-2025

From ACIP updates on age eligibility and research on vaccine efficacy to US adults' attitudes toward recommended shots, these 10 at-a-glance news briefs are must-reads for PCPs.    

10 Essential Vaccine Updates for Primary Care: Winter 2024-2025

A 45-year-old man presents with a chief complaint of worsening diarrhea over the past several months. A scaly hyperpigmented rash is noted on the dorsum of his hands, neck, and shins

He has recently noted more difficulty sleeping and problems with his memory. Which of the following vitamin deficiencies may explain his symptoms?

These symptoms may seem unrelated but are actually classic for a vitamin deficiency. Do you know which one? 

Diarrhea, Dermatitis, Dementia: What One Cause of All? 

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?

What's This "Red Spot"?

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

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 

Rosanna Sutherby, PharmD

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