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then check your diagnosis.
2. Painful lesions on hand
The parents of an 8-year-old boy brought their son to a clinic because they were worried about the painful lesions on the pinkie, ring, and middle fingers of his right hand. The lesions, which had recurred monthly for the past 3 years, typically lasted a few days and then spontaneously resolved. Physical examination revealed numerous skin-colored vesicles on an erythematous base, with overlying crusting and impetiginization over the distal aspects of the fingers. The patient wasn’t taking any medication.
11. Tender red thigh
A 62-year-old man went to see his family physician (FP) because he was concerned about the tender, red, and swollen area on his right thigh that had been bothering him for 3 days. On exam, his temperature was 99.9° F and his thigh had some purulent drainage. The patient’s blood glucose level was 320 mg/dL. He acknowledged that 2 weeks earlier, he’d run out of his oral medications for his type 2 diabetes.
13. Lesions on tongue
A 58-year-old man sought care for painful sores that had been in his mouth, on and off, for a year.
He had lost 20 pounds during this time because it hurt to eat.
The ulcers erupted on his tongue, gums, buccal mucosa, and inner lips.
The patient was not taking any medications.
15. Reticulated erythematous patch on teenager's foot
An 18-year-old Caucasian male sought care for an ill-defined reticulated patch on his right plantar arch (FIGURE 1). The patient said that the lesion had gradually appeared 2 years earlier, had grown slowly, and was occasionally itchy. Physical exam revealed a lacy violaceous, hyperpigmented, reticulated patch that was blanchable and nontender to palpation.
Our patient denied having a history of trauma to the area or a coagulation or connective tissue disorder. The lesion didn’t vary with temperature or season, and there were no known triggers. The patient’s left plantar arch was unchanged.
17. Blisters over sacrum
A 35-year-old woman sought care at our dermatology clinic with the self-diagnosis of “recurrent shingles,” noting that she’d had a rash over her sacrum on and off for the past 10 years.
She said that the tender blisters typically appeared in this area 3 to 4 times per year (FIGURE) and that their onset was occasionally associated with stress. The rash tended to resolve—without treatment—within 5 to 7 days. The patient had no other medical problems or symptoms.
Physical examination revealed 3 groups of vesicular lesions, each on an erythematous base, located bilaterally over the gluteal cleft.
Our patient thought she had a case of “recurrent shingles,” but the location of the blisters and the frequency with which they appeared told a different story.
19. Teen with a diffuse erythematous, pruritic eruption
An 18-Year-old caucasian female sought care at our dermatology clinic for a progressive, erythematous eruption on her face, neck, trunk, and extremities (FIGURES 1A AND 1B). She noted that the eruption had developed suddenly and that it was itchy.
The patient had no significant past medical history and denied being sexually active. The only medication she was taking was mestranol/norethisterone.
The patient denied any new exposures to medications, detergents, or foods. Upon questioning, she did note that about 1 to 2 weeks prior to the skin eruption, she had a mild sore throat and cough. However, her upper respiratory symptoms had resolved by the time she arrived at the clinic.
On physical exam, the patient had multiple erythematous papules and plaques with a fine scale over her face, neck, trunk, and lower legs (FIGURE2). There were areas of confluence on her face and neck. Her palms, soles, nails, and intertriginous areas were spared.
The patient’s mucous membranes were moist and there was no erythema or tonsillar exudate in her pharynx. A complete blood count, basic metabolic panel, and urinalysis were all within normal limits; a rapid plasma reagin (RPR) was nonreactive.
21. Painful rash on face
A 58-year-old man sought care at our clinic for burning in his right eye and a skin eruption on his right forehead and scalp. The pain in both had been getting progressively worse over the previous 10 days. The patient also reported that he had decreased vision in his right eye, as well as a fever, chills, photophobia, and headache. He had a history of psoriasis, which was being treated with adalimumab and methotrexate.
A physical exam revealed vesicles on an erythematous base on his right scalp, forehead, upper and lower eyelids, dorsum of his nose, and cheek (FIGURE). The distribution of the vesicles corresponded to the ophthalmic branch of the trigeminal nerve.
23. Pustular eruption on face
A 30-YEAR-OLD WOMAN came into our clinic for treatment of a facial rash. She said that she first noticed the rash (FIGURE) about 2 months earlier. Over the previous month, the eruption had worsened. Interestingly, the patient noted that she had started Bikram yoga (an intensive form of yoga performed in a room heated, in this case, to 105°F) 5 weeks prior to the onset of symptoms.
She was taking the yoga classes 2 to 4 times a week and said that she experienced an exacerbation of her symptoms after each 1-hour session.
25. Erythematous rash on face
A 27-year-old Caucasian woman came into our clinic with an erythematous, papulopustular rash on her face. The small papules and pustules formed a confluence around her mouth and on her chin; the vermilion border was spared (FIGURE). The patient said that the rash started as a dry scaly patch on the corner of her mouth, and it spread over the course of a few weeks.
The patient had a history of eczema for which she used mometasone furoate cream. Initially, she thought the rash was a flare-up of her eczema, so she used her steroid cream. After using the cream on her face for a month, the patient reported that the rash continued to worsen and spread. She said that the rash was mildly itchy and that when she opened her mouth, it was moderately painful.
27. Painful, erythematous rash on face
A 68-year-old woman came into the clinic for treatment of a painful, erythematous skin rash over the bridge of her nose. She’d had the rash for 4 days, and it was spreading to the malar area and up around her eyelids and forehead (FIGURE 1). The patient said she felt “out of sorts,” was nauseous, and had a low fever. She said she’d recently had a sore throat. Her past medical history included hypertension.
The patient had elevated and indurated shiny skin plaques involving the nose, cheeks, eyelids, and forehead. She also had some blisters and crusty lesions. On palpation, the skin was hot and tender. The pharynx was unremarkable and the neck supple, with no palpable nodes.