An 80-year-old man with a history of congestive heart failure, coronary artery disease, cardiomyopathy, and thoracic and abdominal aneurysms was taken to the emergency department because of mental status changes, back pain, and ecchymotic areas over his body. The ecchymoses started on his back 5 days before admission and spread to his abdomen.
Tan-pink acneiform lesions on the face of a 15-year-old girl had not responded to topical acne therapy. A 1 × 0.5-cm, elevated subcutaneous nodule was noted on the right lateral knee. The lesions on her face and knee had been present for 11 years. The family history was noncontributory.
An otherwise healthy 4-year-old boy was brought for evaluation of a mildly pruritic rash, which had been present for approximately 8 months. The developmental history of the eruption was equivocal, and the child's mother reported no aggravating or ameliorating factors.
The tender, crusted nodule on the lower lip of a 35-year-old man had been growing slowly for 6 months. The patient reported a history of extensive sun exposure.
A 35-year-old man had a 5-year history of progressive hair loss characterized by follicular inflammation with destruction of the follicle and consequent permanent alopecia. Almost the entire scalp was involved. A few pustules were seen on examination, but the clinical picture was mostly one of scarring and irreversible hair loss.
These benign vascular tumors are sometimes seen in pregnancy.
A 69-year-old man with a long history of lymphedema secondary to repeated cellulitis sought medical care for mildly pruritic, nontender, purple nodules that had erupted on the bottom and side of one foot 6 months earlier. Scale surrounded the nodules.
A 41-year-old man sought treatment of the rough, intensely itchy patch on the dorsum of his left foot and lateral ankle. There were no other similar plaques on his body.
A 79-year-old nursing home resident was hospitalized for evaluation of hyperkalemia and leukocytosis. Her medical history included hypertension, respiratory failure with subsequent tracheostomy placement and ventilator dependency, and anemia. Both of her legs had been amputated above the knee secondary to complications of type 2 diabetes mellitus.
Asymptomatic flesh-colored papules were noted on the chest of a healthy 4-year-old black girl. Some of the 1- to 2-mm papules had central, comedo-like crusts. The remainder of the skin was normal.
The mother of a 7-year-old boy with cardiofaciocutaneous syndrome sought treatment for the cutaneous aspects of her son's disease. Dry skin and keratosis pilaris of the upper outer arms were noted.
A 17-year-old high school athlete was anxious about this new “mole” that appeared on the heel of his right foot. His concern was prompted by the recent diagnosis of melanoma in his aunt.
After 3 months of seeing this painless mass at the angle of the 3-year-old's left jaw, his parents sought medical advice for their son. The youngster had no constitutional symptoms. A Mantoux test was performed, and an erythematous, indurated area measuring 15 mm in diameter was found at the test site 48 hours later.
Concerned about a lesion between her eyes, a 91-year-old woman sought medical evaluation. She had not seen a physician for 23 years.
A boy was born to a gravida 2, para 1, 26-year-old woman at 37 weeks' gestation. The pregnancy had been complicated by gestational diabetes.
The pigmented hairy nevus that covers the entire right upper arm of this 18-month-old boy has been present since birth. More than 95% of large, congenital pigmented nevi have a hairy component.
This erythematous, papulovesicular eruption developed in a hospitalized patient who had a febrile illness that was accompanied by drenching sweats. Miliaria rubra, or prickly heat, is caused by sweat trapped in obstructed eccrine glands of the epidermis. Inflammation, irritation, and pruritus can occur along with the rash.
An otherwise healthy 34-year-old woman was concerned because of the abrupt onset of rapid hair loss, accompanied by scaling of the underlying skin. The disorder had begun 3 months earlier, and the right parietal and temporal areas were now red and swollen and had adherent scale. An antinuclear antigen titer was negative. Biopsy revealed changes consistent with lichen planus of the scalp, also known as lichen planopilaris and lichen planus follicularis.
A mildly itchy, tender “red bump” on his eyelid concerned a 68-year-old man. Two years earlier, a basal cell carcinoma, which started as a “red bump,” had been removed from his cheek. This lesion had been present for 2 weeks; the patient noted a small amount of discharge at the site in the mornings.
A 21-year-old woman had suffered recurrent nosebleeds and pain in her nose for the previous 2 months. Physical examination revealed an extremely vascular, slowly enlarging intranasal growth on the anterior surface of the septum.
A 10-year-old boy presented with a 6-month history of a painless mass on the left side of the scrotum. The overlying skin had a bluish discoloration. The mass felt like a “bag of worms.” When the boy stood, venous varicosity could be palpated along the spermatic cord. This venous distention increased when he performed Valsalva's maneuver and decreased when he was recumbent.
A 76-year-old man reported a 3-month history of an asymptomatic, raised, reddened lesion on his penis. The patient had type 2 diabetes mellitus. In 1994, a basal cell carcinoma had been excised from his chest and, 3 years later, a squamous cell carcinoma was excised from his left temple.
A 42-year-old woman presented with a papular eruption that first appeared during childhood. Severe pruritus, which worsened during the summer, accompanied the lesions. The patient reported that family members, including her mother and brother, had a similar skin problem.
A 44-year-old woman was being seen regularly for skin manifestations of systemic lupus erythematosus (SLE). During a routine visit, blotchy erythema and hyperpigmentation were noted on the normally exposed areas of her neck and upper chest; the submental area was spared. Close examination revealed fine telangiectases and poorly marginated hyperpigmented and hypopigmented macules.
A 28-year-old man presented to the emergency department with a 1-week history of multiple, concentric, erythemic, targetlike plaques over the entire body. Severe necrosis and hemorrhagic crusting were evident on the oral mucosa and lesions were present on the upper lip. The remainder of the physical examination was unremarkable. The patient had no known medical problems, was seronegative for HIV, and denied a history of herpes simplex virus (HSV) infection. He used no medications.
