Dermatology

During a routine examination, these changes are noted on both thumbnails of a 56-year-old man. He denies any trauma or underlying diseases.

After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather.

For several months, a 28-year-old man has had these changes to his nails, which have also become more brittle. He denies any history of trauma to the nails.

Asymptomatic lesion on the dorsum of a 15-year-old boy’s left hand extends on to the first 2 fingers and has produced nail dystrophy. The patient is otherwise healthy and denies any history of trauma to the hand.

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier.

A tender, crusting eruption first arose on a 69-year-old man’s ear 10 days earlier; an antibiotic failed to clear the lesion.

Several months earlier, this asymptomatic, pigmented, hard nodule arose on the upper arm of a 37-year-old woman.

For 5 days, a 68-year-old woman has been bothered by a painful swelling on her left cheek. There is no history of trauma or bite. She takes a diuretic for mild hypertension. Amoxicillin/clavulanate was started 2 days earlier pending the results of a bacterial culture.What is the likely diagnosis?

Eczema is confined to the dorsum of a 37-year-oldwoman’s hands. She had been applying an over-thecounter,topical antifungal cream but noted no changein the rash. The patient is a hairdresser and enjoyskickboxing.

For a few weeks, a 36-year-old woman has had this pruritic labial rash.

A 43-year-old woman with chronic hip pain presents with an asymptomatic eruption on the hip of several months' duration. She has been using a heating pad at night for pain relief because NSAIDs have not been effective.

A 32-year-old woman presents for evaluation of itching in the pubic area.

For 9 months, a 39-year-old woman has had a pruritic rash on the posterior portion of one thigh. She had consulted another physician, who prescribed a medication that she does not recall, but there was no improvement.

During a routine checkup, a 14-year-old girl inquires about a large red spot on her right ankle. The asymptomatic, erythematous area overlying the malleolus has been present for several months.

An itchy facial rash of 1 week's duration prompts a 72-year-old woman to see her primary care provider. She reports that redness and scaling had developed on her cheek, and that vitamin E oil she applied to the area seems to have made it worse.

An obese 60-year-old woman presents with a chronic malodorous, itchy rash in her groin.

During a routine skin examination, a papule of several years’ duration is noted on the upper lip of a 71-yearold man. The patient states that the lesion has been slowly enlarging; it does not bleed even during shaving.

A 33-year-old woman presents with an asymptomatic facial rash for which she has been using mometasone cream regularly. Initially, she had a small patch of acne on one cheek that quickly cleared with this cream. However, the rash has been worsening for the past year.

For several months, a 51-year-old African American woman has had an asymptomatic erythematous papule on the nose. She is otherwise healthy.

For several weeks, a 33-year-old man has had an asymptomatic lesion on the head of the penis. He has had a new sex partner in the past few months but is unaware of any health problems she may have. What is the likely cause of this lesion?

A 35-year-old man presents with a scaling rash on the penis of several weeks’ duration. Which of the following would you include in the differential?

Is this penile rash the result of lichen planus? Candidiasis? A dermatophyte infection? Seborrhea? Psoriasis? Click here for the answer.

For 2 months, a 27-year-old man has had this worsening rash on the head of the penis. He denies any history of trauma. What do you suspect?

Case 4: An obese 59-year-old man presents with a chronic malodorous, itchy rash in his groin.

For a few months, a 27-year-old man has had an itchy rash in the groin area. He tried an over-the-counter “jock itch” remedy, but it was not effective. He is otherwise healthy.Which of the following would you include in the differential diagnosis?

A 28-year-old man presents for evaluation of a nonresolving rash in his groin. The rash has persisted despite the patient’s use of over-the-counter antifungal creams. What do you suspect?

This abdominal rash developed while a 63-year-old woman was traveling in Israel. She was admitted to the hospital, where she received intravenous antibiotics, and was discharged after 5 days. She now returns to the United States and wonders what she had, because she did not understand what the physician in Israel had told her. She has brought all of her medical records.

For 10 days, a 42-year-old woman has had this asymptomatic eruption on her trunk and proximal extremities. She is otherwise healthy.

A 63-year-old woman presents with a tender nodule of 10 days’ duration on the dorsum of her right hand. She does not remember any specific injury, but she does do her own housework. Another physician prescribed doxycycline, 100 mg bid; however, the nodule has persisted. You order a bacterial culture.

For 1 week, a 28-year-old man has had this tender, spreading rash on his chin. He is otherwise healthy. What does this look like to you?