Photo Rounds Friday Archive

Itching and crusting of hands

Post Date: 12/18/2009

FIGURE 1	FIGURE 2
Click to see full size image

A 2-year-old boy was brought in for treatment of severe itching and crusting of his hands. He also had a pruritic papular rash over the rest of his body. He’d had this problem since he was 2 months old and had received topical treatments that provided only temporary relief. Other adults and children in the house were beginning to itch and get a rash, as well.

What's your diagnosis?

Body itch

Post Date: 12/11/2009

FIGURE 1	FIGURE 2
Click to see full size image

A 64-year-old woman with schizophrenia went to a homeless clinic because her whole body was itchy. She said that she could see creatures feeding on her and moving in and out of her skin. The physical exam revealed that she was unwashed and had multiple excoriations over her body.

What's your diagnosis?

Rash on trunk

Post Date: 12/04/2009

FIGURE 1	FIGURE 2
Click to see full size image

A young woman came into the office with a rash on her trunk. She’d had the rash for 3 months and had no symptoms, but was worried that it would spread to the rest of her body.

What's your diagnosis?

Painful mouth sore

Post Date: 11/27/2009

Click to see full size image

A 19-year-old woman went to her doctor for treatment of a painful sore that she’d had in her mouth for almost a week. She denied fever or chills, and indicated that she may have traumatized the area with a firm toothbrush she’d gotten a few days before.

What's your diagnosis?

Pruritic rash on abdomen

Post Date: 11/20/2009

Click to see full size image

A 26-year-old woman (gravida 1, para 0) at 36 weeks of pregnancy sought care from her family physician for a progressively itchy rash. The papular rash started within the abdominal striae and spread to her proximal extremities. The patient said that the itching “was maddening.” Her prenatal course was otherwise normal and she had no other symptoms.

What's your diagnosis?

Painful, swollen eyelid

Post Date: 11/13/2009

Click to see full size image

A 35-year-old man sought treatment for his left eye, which had been swollen and painful for the past 3 days. He had a nodule on the upper eyelid and a small yellow-white papule on the lower eyelid. He also had crusting on the eyelashes. His vision was unchanged and there was no pain in the orbit itself.

What's your diagnosis?

Mass in mouth

Post Date: 11/06/2009

FIGURE 1	FIGURE 2
Click to see full size image

An elderly woman went to her physician’s office for a physical exam. While looking in her mouth, the physician noted a mass at the midline of the hard palate. The patient indicated that she’d had this for her whole adult life and it did not bother her.

What's your diagnosis?

Pustules on arms and thigh

Post Date: 10/30/2009

Click to see full size image

A healthy 29-year-old woman sought care at a clinic for pustules and boil-like lesions in the axillary areas, on the left forearm, and on the right thigh. She’d had the lesions for 4 weeks, and indicated that she’d not had any recent infections. There was no evidence of immune compromise in her history. Her physician incised a pustule, expressed the pus, and sent it out for bacterial culture and sensitivity testing.

What's your diagnosis?

Body rash

Post Date: 10/23/2009

Click to see full size image

A 56-year-old man sought care for an extensive rash over his entire body. It had started 2 months earlier in the gluteal region and spread to his hands, arms, trunk, legs, feet, and most recently, his face. He had extensive pruritus and was uncomfortable. He said he drank 1 bottle of gin a day and had done so for the last 20 years. He denied previous skin problems. He also denied any fevers, chills, or night sweats. On physical exam he had large erythematous plaques with white scales on his hands and most of his body. He also had extensive nail changes on his right hand. A 4-mm punch biopsy was performed.

What's your diagnosis?

Bumps on abdomen

Post Date: 09/16/2009

FIGURE 1	FIGURE 2
Click to see full size image

A 4-year-old boy was brought into the office because of bumps that had broken out on his abdomen 3 months earlier. He occasionally scratched them, but they were otherwise asymptomatic. His mother was unhappy with the appearance of the bumps and wanted them removed.

What's your diagnosis?

Growths on penis

Post Date: 10/09/2009

Click to see full size image

A 46-year-old man sought care for 2 growths on his penis. He said that the growths had developed over the past year, and that he’d had 2 female sexual partners over the last 2 years. He had not been using condoms. He asked if he could be tested for sexually transmitted diseases (STDs) and that the growths be removed as soon as possible. The patient denied any urethral discharge or burning on urination. Otherwise, he was in good health.

What's your diagnosis?

Rash on hands, feet, and mouth

Post Date: 10/02/2009

Click to see full size	image

A mother sought treatment for her 4-year-old son at a free clinic for homeless families. Her son had a low-grade fever and lesions on his hands and feet. The mother indicated that 2 other children in the transitional living center where they were staying had a similar rash. Upon further investigation, the physician noted mouth lesions, as well.

What's your diagnosis?

Growths on finger

Post Date: 09/25/2009

Click to see full size image

A 22-year-old man sought care for 3 uncomfortable growths on his finger. The growths had been there for the past 6 months. He was in otherwise good health, but said that the lesions interfered with his typing.

What's your diagnosis?

Rash in both axillae

Post Date: 09/18/2009

Click to see full size image

A 12-year-old girl came into the office with her mom because of a red irritated rash in both axillae that she’d had for a year. She had been seen by several doctors who recommended various antifungal creams that did not work. Even hydrocortisone didn’t help. The patient had stopped using deodorant, worrying that she was allergic to it.

What's your diagnosis?

Erythematous malar rash

Post Date: 09/11/2009

Click to see full size	image

A 2-year-old boy came in with mild, flu-like symptoms and a rash. He had an erythematous malar rash and a temperature of 100.1º F. No one else in the family was ill, but he did attend day care. Besides the rash and fever, the remainder of his physical exam was normal.

What's your diagnosis?

Rash on chest

Post Date: 09/04/2009

Click to see full size image

A 29-year-old woman came in with a rash that she’d had for 2 days. She felt a bit feverish; her temperature was 99.9º F. Her husband--a physician--did not have a rash or fever. On close inspection of the rash, there were a few vesicles and papules. Her lungs were clear and there were no other signs of infection.

What's your diagnosis?

Lesions between breasts

Post Date: 08/28/2009

Click to see full size image

A 45-year-old woman sought care for tender draining lesions between her breasts. The lesions had been there for years. She indicated that she occasionally had painful “boils” in the groin, though none in the axilla. She had no idea why she kept getting these “boils.” She said that it was painful to have them opened and wanted to know how to stop them from forming.

What's your diagnosis?

Bumps on face

Post Date: 08/21/2009

Click to see full size image

A 28-year-old African man came to the office because he was bothered by uncomfortable bumps on his face that had been there for years. He said that the bumps got irritated and larger when he shaved. He indicated that his work involved providing aid for Darfur refugees.

What's your diagnosis?

Bumps on nose

Post Date: 08/14/2009

Click to see full size image

A 51-year-old Hispanic man came into the office because he was disturbed by the appearance of his nose. He denied any pain or itching of the nose. He was particularly upset that children had been pointing at his nose and appeared to be making fun of him. He acknowledged a history of heavy drinking in the past, but had stopped drinking alcohol completely.

What's your diagnosis?

Large red mass on face

Post Date: 08/07/2009

Click to see full size image

A 22-month-old girl was brought to the office by her mother because of the large red area on her face. The mother noted that it had been there since birth, grew larger during the first year of life, and had begun to shrink some. The mother wanted to know if it would go away, and if there was anything that could be done about it.

What's your diagnosis?

Blisters on back

Post Date: 07/31/2009

Click to see full size	image

A 57-year-old man sought treatment for blisters on his back and arms that had developed 2 weeks earlier. He had hypertension and was recently started on metoprolol. He denied previous dermatologic disease and was otherwise feeling well. Pressure applied directly to the bulla did not cause lateral spread.

What's your diagnosis?

Red and swollen area on nose

Post Date: 07/24/2009

Click to see full size image

A 45-year-old black woman sought treatment for a red and swollen area on her nose. The lesions, which had developed 2 months earlier, were not painful or pruritic but the patient was worried about their appearance. She had hypertension, but no other medical problems. She had no respiratory complaints.

What's your diagnosis?

Occasionally pruritic rash

Post Date: 07/17/2009

Click to see full size image

A 17-year-old woman was brought to the office by her mom because of a rash that she’d developed 3 weeks earlier. She was feeling well and the rash was only occasionally pruritic. With and without her mother in the room, the young woman denied sexual activity. Her palms and soles were spared.

What's your diagnosis?

Skin change on forehead

Post Date: 07/10/2009

Click to see full size image

A 41-year-old Hispanic woman noticed a change in the skin of her forehead over the past 3 years. Her forehead didn’t hurt or itch, but she was concerned about the changes to her skin. She was otherwise in good health and wasn’t taking any medications.

What's your diagnosis?

Red pruritic area on forehead

Post Date: 07/03/2009

Click to see full size image

A 55-year-old woman sought treatment for a red pruritic area on her forehead. She reported that that the redness and itching had developed 3 months earlier. The patient had hypertension, which was well controlled. She had no other health problems.

What's your diagnosis?

Flat lesions on thigh

Post Date: 06/26/2009

Click to see full size image

A 26-year-old woman sought treatment for multiple flat lesions on 1 thigh. She said that at first there had been just a few lesions, but over the past 3 months, they had spread. She had no pain or itching. She reported that she shaved that part of her leg.

What's your diagnosis?

Rash on back

Post Date: 06/19/2009

Click to see full size image

A 7-year-old girl came into our office with a widespread rash on her back and buttocks. Her mother reported that the rash started 3 days ago and she was concerned because it appeared to be spreading. The child did not appear ill, but said the rash was uncomfortable.

What's your diagnosis?

Painful sore on finger

Post Date: 06/12/2009

Click to see full size image

A 58-year-old woman came in with a painful sore on her index finger that had been bothering her for 2 days. She had no idea what brought on the lesion, but she wanted the pain to stop.

What's your diagnosis?

Recurrent pruritic vesicles

Post Date: 06/05/2009

Click to see full size image

A 1-year-old boy was brought in for a second opinion about the recurrent pruritic vesicles and pustules on his hands and feet. This was the third episode and in both of the previous episodes, the doctors thought the child had scabies. The child was treated with permethrin both times and within 2 to 3 weeks the skin cleared. No other family members had lesions or symptoms.

What's your diagnosis?