Skin Diseases

The left ear of a 1-month-old infant girl shows a congenital papillomatous lesion at the preauricular area. She had no other apparent abnormalities.

While doing yard work, a man experienced acute, severe, burning pain on relatively brief contact with the caterpillar Megalopyge opercularis. The lesion shown in the photograph developed subsequently. Each red papule represents the site of direct cutaneous envenomation by the insect's poisonous body hairs. The caterpillar can vary in color from white to dark brown, depending on the surroundings and time of year. The fuzzy hairs resemble a cat’s fur; hence the nickname “puss.”

The patient reported that he had noticed the facial eruption a couple of months earlier. On examination, the lesion appeared more plaque-like and dense than is typical of rosacea. The differential diagnosis included lupus, mycosis fungoides, rosacea, and angiosarcoma.

The lesions seen here developed shortly after a 54-year-old woman started psoralen plus UVA (PUVA) therapy for psoriasis. This is acne estivalis, an uncommon actinic, acneiform eruption. The firm, red, monomorphic papules are most commonly found on the shoulders, arms, neck, and chest. Histologically, they resemble steroid acne. Lesions develop in the spring, peak in the summer, and resolve in the fall without scarring.

Seen here are a 38-year-old Native American woman and her 20-year-old daughter, each of whom has had a relapsing eruption for several years. Pruritic, red to red-brown plaques develop on their faces and necks and on the dorsal surface of their hands. Scattered brown and hypopigmented macules as well as some scaling and slight erythema appear on their lower lips. The women stated that the eruptions flare each spring and gradually improve throughout the rest of the year. The daughter's lesions were more acute at this time and had developed during the preceding 3 days.

The frontal and bitemporal hair recession generally seen in men with androgenetic alopecia is not typical in women, who instead tend to undergo a diffuse thinning of hair on the crown.

Cyanosis involving the hands and toes of a 12-year-old girl was first noted 3 months before medical evaluation was sought. Her fingers and palms were red, the nail beds were cyanotic, and her palms were cold and sweaty. The girl's toes were cyanotic when she was standing. Her hands and feet reverted to a normal color when the limbs were elevated.

The rash of tick tularemia is seen here on the arm of a 5-year-old boy. He also had a tick bite on his back that became necrotic and ulcerated. Within 2 weeks of his having been bitten, axillary lymph nodes developed.

A 37-year-old man presented with fever, chills, myalgia, headache, and left-sided pleurisy of 2 weeks' duration. He also complained of weight loss and loss of appetite. The patient had recently returned from a family visit to Missouri.

The wounds on the back of this boy's head resulted from an encounter with his neighbor's dog. The youngster's anxious parents brought him in for evaluation 1 hour after he was bitten.

A 1-year-old girl was noted to have abrasions on the left cheek when she was picked up by her mother from a day-care center. The day-care provider reported that the girl had been bitten on the cheek by a 3-year-old boy during rough play. Her immunization status for tetanus was up-to-date.

A 53-year-old man presented with a 3-day history of bilateral pain in the lower extremities. He also had a 3-month history of thickening and desquamation of skin, with associated itching, and a 5-lb (2.27-kg) weight loss. The skin changes initially appeared on the hands and subsequently became generalized.

This painless, bleeding lesion had developed insidiously on the penis of a 47-year-old HIV-positive man. The patient was inconsistently compliant with antiretroviral therapy. He had a history of Pneumocystis carinii pneumonia and widespread cutaneous Kaposi sarcoma. The 2.5-cm, friable but firm, exophytic nodule was on the distal shaft of the penis.

A tender nodule; an itchy truncal rash; multiple pruritic eruptions--can you identify the disorders pictured here?

A dermatologic comedone extractor is an excellent tool to aid in the removal of fine foreign bodies, such as cactus needles, small splinters, and insect stingers, that are embedded in the skin.

A 3-year-old girl discovered lesions on her instep and great toe, where there was significant pressure from the old rubber sandals that she had been wearing.

Two days after beginning therapy with amlodipine, this 30-year-old woman noticed a pruritic, erythematous, macular dermatitis on her ankles.

What is the best way to obtain skin scrapings and evaluate them for evidence of fungal infection?

A 3-month-old boy was initially evaluated for a skin-colored, 1 × 3-cm, diffuse swelling in the right superior orbit area. The lesion had been slowly growing for a month and was asymptomatic. He was referred to a pediatric ophthalmologist who administered 2 corticosteroid injections intralesionally.

Excessive sweating may be caused by a variety of conditions or prescription drugs.

A 70-year-old woman complained of an infection in the right index fingernail and surrounding skin of 18 months' duration. The modest swelling and tenderness of the proximal paronychial tissue, faint nail dystrophy, and separation of the cuticle from the nail plate had persisted despite several courses of oral and topical antibiotics. The patient had occasionally seen pus seeping from underneath the cuticle. Results of a bacterial culture, performed by another physician, were negative.

A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration. Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.

In Dr Henry Schneiderman's interesting case of swelling and redness of the lids in an elderly woman, the photograph clearly illustrates a sharp demarcation of the area of swelling above the cheekbone.

Is this acneform eruption on a middle-aged woman’s face perioraldermatitis? Rosacea? Pyoderma faciale? Is this pruritic rash related to ayoung woman’s tanning salon visits? Scrutinize the photos, make yourdecisions, and compare your answers with an expert’s.

Rickettsia rickettsii is transmitted tohumans by a tick bite. This boy hadbeen camping a short time beforea fever and the classic rash of RockyMountain spotted fever developed.The erythematous macular rashfirst appears on wrists and anklesand spreads to the trunk. Note thepuffy appearance of the skin resultingfrom vasculitis.

For a year, a 31-year-old man had asymptomatic, malodorous discoloration of the toe web spaces. He stated that his feet perspire heavily in the boots he is required to wear for work.

Painful cysts on the sternal and left axillary regions that had worsened over the past 3 weeks prompted a 42-year-old man to seek medical care. He reported that similar lesions in the same distribution first arose when he was 25 years old, and they recur each year. He denied having cystic acne in adolescence.

Appropriate foot care, preventive measures, and early intervention reduce the incidence of complications and lower extremity amputation in patients with diabetic foot ulcers. A thorough lower extremity examination includes assessment of the skin, interdigital areas, skin quality and integrity, and ulcerative or pre-ulcerative changes. The key to prevention is patient education and lifelong commitment to self-care.

This 9-year-old girl had a slightlypruritic perioral rash for 6 months.The skin around her mouth wasred, scaly, thickened, and hyperpigmented.She also had eczematouslesions in the antecubital andpopliteal fossae.

The multiple, uniformly scaly, coin-shaped, papulosquamous lesions shown here on the lower leg of a 61-year-old man had persisted for 3 months despite application of topical clotrimazole and 1% hydrocortisone. The rash involved only the legs and was variably pruritic. The patient had a long history of dry skin.