What caused this painful skin erosion?

May 15, 2012

A woman was referred to dermatology for evaluation of striking changes to the skin of both ankles, including star-shaped scarring and skin erosion.
 

A widespread rash that 
interfered with sleep

April 06, 2012

An older man complains of a persistent pruritic rash that began in the summer heat and was exacerbated by sweating.
 

A facial lesion concerns an at-risk patient

March 08, 2012

The lesion was asymptomatic, but the patient's history raised her own index of suspicion, not just the clinician's.
 

Lesions that continue to recur in the same place

February 08, 2012

An elderly woman seeks evaluation for skin lesions that recur so consistently that they occupy the same location episode after episode.
 

What is behind this postpartum puzzler?

January 10, 2012

A young mother has a healthy baby boy—and a new-onset vesicular, bullous rash that developed very quickly after the birth.
 

Nodules that developed months after treatment

, Daifullah Al Aboud, MD December 08, 2011

A travel history and biopsy results led to a quick diagnosis and successful treatment—until new lesions made their appearance.
 

How is this web space lesion best treated?

November 09, 2011

Deciding the best approach to a hard-to-monitor lesion of unknown duration required judgment based on both objective and subjective input.
 

Is this edema and firming of the skin a severe sign?

October 11, 2011

This female patient experiences a series of unusual changes on the skin of both her hands: edema, whitening and pain in the fingertips, and cyanosis.
 

What caused the rash 
on this 
high school 
athlete?

September 07, 2011

A high school athlete develops a number of multiplying pink and slightly translucent papules on the right and left sides of the neck.
 

What caused these itchy white bumps on the wrists?

August 09, 2011

A 43-year-old man wishes to have a number of white, terribly pruritic papules and nodules on his wrists reevaluated.
 

What is this psoriasiform plaque?

, Amor Khachemoune, MD, FAAD July 06, 2011

A male patient presents with an expanding, erythematous region on his right knee that had proved unresponsive to topical corticosteroids.
 

What is this slow-growing preauricular lesion?

, Amor Khachemoune, MD, FAAD June 07, 2011

A 78-year-old white male presented for evaluation of a steadily growing, increasingly red, pruritic lesion on the right side of his neck below the ear.
 

What caused this woman's addiction 
to steroids?

May 04, 2011

After a facial eruption persists for over 6 months and the patient experiences tingling after discontinuing a steroid cream, she presents for evaluation of the condition.
 

What caused this spotted, itchy rash on the shins?

April 06, 2011

A female patient presents with multiple reddish to brown lesions that were present for over a year but had recently multiplied.
 

What caused these unusual bumps on the left eyebrow?

March 11, 2011

A female patient presents for evaluation of unusual bumps along her left eyebrow.
 

What caused this pruritic 
eruption of the armpits?

February 04, 2011

A woman presents with a papular follicular eruption that has been present for the past 3 months and has not responded to several OTC treatments.
 

Just how 
dangerous is this forearm 
lesion?

January 06, 2011

A patient with leathery, sun-damaged skin presents with a fixed but growing lesion on his left arm.
 

What caused this hair loss on the scalp?

December 07, 2010

A 10-year-old boy with hair loss in the vertex area of the scalp, chronic anxiety, and attention deficit disorder presented for evaluation.
 

Unusual depressed areas on 
the arm 
and buttock

, Amor Khachemoune, MD, FAAD November 01, 2010

A female patient presents for evaluation of two indentations and hypopigmented areas that had been present for the past 7 months.
 

What are these lesions that spread from the lips?

October 12, 2010

A female patient presented with asymptomatic lesions on her lips, face, and arms that had persisted for the past 6 months.
 

Round, pitting lesions on 
the lower leg

September 07, 2010

A patient with diabetes mellitus presents with a pitting rash on the right lower leg that had persisted for a year.
 

Is this lesion on the gum a worrisome sign?

, Thomas A. Chiodo, DDS August 10, 2010

Excision and biopsy are used to evaluate a slow-growing, asymptomatic lesion on the patient's right upper gum.
 

Slight rash develops into a refractory lesion

July 13, 2010

Constant itching and frequent scratching of a slight rash lead to a recalcitrant depigmented lesion that defies diagnosis.
 

Is urtication of this solitary bump a worrisome sign?

June 08, 2010

An infant presents with a single asymptomatic lesion that becomes raised and puffy with stroking.
 

Why won't this rash respond to treatment?

May 07, 2010

Despite numerous therapeutic attempts, the rash continued to spread, involving more and more of the patient's groin.
 

Should this patient be more concerned about her cyst?

April 09, 2010

Despite having a risk factor for skin cancer, this woman waited 5 years before having the cyst on her arm evaluated by a clinician.
 

Does this young girl have the same rash as her mother?

March 05, 2010

The daughter of a woman with psoriasis vulgaris develops an alarming rash after exposure to several possible aggravating factors.
 

What approach should be used for a lesion on black skin?

, Mark Ling, MD, PhD February 05, 2010

The diagnosis and treatment of a skin disorder that is uncommon in black persons is reviewed.
 

What is the best way to manage this severe rash?

January 08, 2010

This common skin disorder can be managed with simple hygiene practices and OTC products. Parental education is the most valuable tool.
 

Why won't this rash respond to treatment?

December 04, 2009

This patient had chronic conditions she managed with a combination of clinical and self treatments. Is one of them perpetuating her rash?
 

Is this skin diseased, or is it just dirty?

Claudio Guarneri, MD; Serafinella Patrizia Cannavò, MD November 04, 2009

Two brothers are brought to clinic with a mysterious dirty appearance to their skin that did not resolve with routine cleaning.
 

Underarm rash worsens with OTC treatment

, October 07, 2009

A patch of irritated skin on this patient's axilla developed into a pruritic rash that worsened with OTC treatment. Punch biopsy revealed the diagnosis.
 

Should this periocular lesion be biopsied?

September 09, 2009

Choosing the appropriate biopsy—and getting the patient to agree to it—are crucial for diagnosing a facial lesion.
 

Pruritic rash on the legs of a sports enthusiast

August 12, 2009

What caused the gradually worsening rash that appeared on this man's legs 6 hours after he completed a round of golf in the South Carolina sunshine?
 

Hairy plaque on an infant's back and extremities

Ingrid Mody, MMSC, PA-C; Melissa Shaw, PA-C July 08, 2009

The baby had good Apgar scores and demonstrated normal movement, but MRI suggested abnormalities in the amygdala of the right posterior temporal lobe.
 

A spreading, chronically itchy rash

Lisa A. mainier, PhD, PA-C, DO June 05, 2009

A pruritic rash that started on the chest and spread to the patient's back is worsened by warmer temperatures.
 

Is this small lingual lesion benign or threatening?

, Heather Kurdali; Thomas Chiodo, DDS May 07, 2009

A 40-year-old female found a small but growing red lump under her tongue. She did not smoke tobacco or drink alcohol, nor did she have a history of doing so.
 

An enlarging lesion on the knee of a teenager

April 03, 2009

A 16-year-old boy came to the dermatology clinic seeking evaluation of a lesion on his knee. Alarmed at the lesion's changing appearance and increase in size, the boy's parents consulted his pediatrician who, in turn, referred the family to dermatology.
 

What caused the total hair loss in this young boy?

March 06, 2009

Hair loss is devastating at any age, even for older persons with hereditary predisposition. But it is especially troubling for children, in whom alopecia is surprisingly common.
 

Does this man have genital warts?

February 06, 2009

A 26-year-old man self-referred himself to the dermatology clinic for evaluation of "genital warts" that had not responded to OTC wart medication. The lesions had been present for several years unchanged, caused no symptoms, and had never appeared in any other locations.
 

A rash that "traveled" over the top of the foot

Sandra Morris, MMSc, PA-C; Steven Marcet, MD January 01, 2009

A 47-year-old female presented to our dermatology clinic with a recent history of vacationing in Panama City, Florida. Three to four days after returning home, she developed small blisters, severe pruritus, erythema, and swelling on the right dorsal foot between the fourth and fifth toes. She noticed that the rash "moved," making a path across the top of her foot.
 

Painless growths felt like stones in her shoes

Cheryl L. Green, PA-C December 01, 2008

A 24-year-old white female presented to the dermatology clinic with a 2-year history of growths on the soles of her feet. The growths were not painful when walking, but felt like "a bunch of stones in her shoes." The patient tried several OTC callous-removal products, but they were ineffective.
 

Too much attention makes this problem worse

November 01, 2008

The patient is a 33-year-old woman who was referred to the dermatology clinic for evaluation of a rash on the periorbital skin of both eyes that had been present off and on for months.
 

A common lesion causes a great deal of worry

Joe R. Monroe, PA-C, MPAS October 01, 2008

A 44-year-old woman presented to the dermatology clinic with a lesion on her leg. She did not know exactly how long it had been there. She said that most of the time, the lesion produced no symptoms, although occasionally it caused an "itchy, crawly" sensation.
 

Did this young girl brush too vigorously?

Denise Rizzolo, PA-C, PhD; Thomas Chiodo, DDS September 01, 2008

A 16-year-old female presented with a painless lesion on her upper gingiva. She reported that about 4 weeks ago, her gums began to bleed while she was brushing her teeth.
 

What caused discolored skin on this man's legs?

Casey J. Barcomb, PA-C August 01, 2008

The patient is a 74-year-old male of Asian descent with a 6-week history of asymptomatic bullae and associated discoloration on his legs.
 

A serious condition or a benign masquerade?

David Payton, MA, MMS, PA-C; Christopher Reardon, PhD, MD; Michel Statler, MLA, PA-C July 01, 2008

Dermatology Digest
 

The lesion on this patient's tongue really hurts

June 01, 2008

A 56-year-old female was referred to dermatology by her primary care physician for evaluation of a moderately painful lesion on her tongue. On examination, a 2-cm, ovoid-shaped erosion was noted on the left lateral aspect of the tongue.
 

Worrisome perioral rash on a young boy

May 01, 2008

A 9-year-old African-American male was brought to the dermatology clinic by his mother because she was concerned about a dark, elevated, ringshaped rash around the boy's mouth. The rash had progressively worsened over the past year.
 

Is this lesion a cause for concern?

April 01, 2008

The patient was a 27-year-old woman with a lesion on her ear first noticed by her mother. The mother suggested that the patient have the lesion evaluated by a dermatology specialist. The patient's sister had a history of low tolerance for sun exposure and had had a melanoma several years earlier.
 

What caused the rash on this elbow?

March 01, 2008

A 4-year-old girl was referred to dermatology by her pediatrician for evaluation of a slightly itchy rash on her arms, legs, and buttocks that had been present for 2 weeks. The child had had a recent upper respiratory infection.
 

Painful sores in a young boy's mouth

, Thomas A. Chiodo, DDS February 01, 2008

The patient was a 7-year-old boy who presented with painful sores in his mouth. Three days before presentation, the patient complained to his mother that his mouth felt extremely painful. He said the pain was worse when he ate or drank. On examination, his mother noticed multiple small ulcers all over the inside of the boy's mouth. She administered an OTC oral anesthetic spray, but this did not relieve the pain. The patient had no associated fever, chills, headache, rash, sore throat, nasal congestion, or cough.
 

A rash and swelling around a puncture mark

, Stanley C. Parman, MD, FACEP January 01, 2008

The patient is a 6-year-old boy who noticed a small red bump on his kneebefore going to bed. The next morning, he found redness and swelling around the initial bump, and the area felt itchy but not painful. He was able to bend his knee and walk without difficulty. He felt well otherwise and denied any fever, chills, headache, sore throat, congestion, or joint pain. No symptomatic treatments were administered.
 

A potent mix noses in on this patient

December 01, 2007

Some individuals are at higher sun exposure risk than others. In these high-risk people, overexposure to UV light produces predictable changes in the skin, several of which can be seen on the nose of the 54-year-old man.
 

Simply a pimple or is it worse?

November 01, 2007

An 8-year-old girl was brought to the clinic by her mother for evaluation of a lesion that had been on her face for more than a year. The lesion grew to its current size and had stabilized at that size a few months before our evaluation. The patient and her mother denied that there was any pain or discomfort in the area. Both parent and patient also denied that the patient had any history of previous trauma.
 

Reaction to OTC cream identifies rash

October 01, 2007

The patient is a 52-year-old man who has suffered from an itchy rash on his chest for more than 20 years. He had consulted any number of health care providers in that time and tried several prescription topical treatments. Only one treatment was found to somewhat relieve his symptoms. A clotrimazole/ betamethasone combination cream briefly relieved the itching; it did not, however, clear up the rash.
 

A rash more than just skin deep

September 01, 2007

A seemingly healthy 55-year-old woman experienced muscle weakness that grew progressively worse over a 6-month period. She also developed an asymptomatic rash on her face and the dorsa of her hands and arms. After both problems had continued for another month, the patient was prompted to visit her primary care provider (PCP), who ordered blood tests. CBC and chemistry screen results showed no abnormalities. The PCP prescribed an NSAID and a topical steroid cream, neither of which resolved the problems
 

Early detection saves an elderly woman

August 01, 2007

An 87-year-old white woman presented to our dermatology office for evaluation of a nonhealing wound on the great toe of her right foot.
 

Multiple bumps seen on the heels

Lindsay Payton July 01, 2007

A 25-year-old white female was referred to the dermatology clinic for evaluation of bumps on her heels. The patient reported that the asymptomatic bumps had been on her heels for "as long as I can remember."
 

Puzzling brown area on toddler's skin

June 01, 2007

A 24-month-old mixed Asian Caucasian female presented with an asymmetrical "darkening" of the skin along the anterior trunk. The mother noticed the skin changes when the child was around 15 months old; the pigmentation contrast has increased slightly since then.
 

A rare ulcer with a common cause

, Robyn Giesseking, PA-C May 01, 2007

A 65-year-old woman presented to our primary care clinic with a lesion on her right superior abdomen that began as a small red bump and progressed into a large, painful ulcer.
 

Acute episode or chronic problem?

April 01, 2007

A 59-year-old man presented with acute swelling of his lips and face. The swelling began about 2 hours before he arrived and was slowly resolving. Although the patient had experienced this swelling before, this instance was the first time his lips were affected. The patient denied any shortness of breath but admitted to a lifelong history of atopy marked by asthma, hives, seasonal allergies, and eczema.
 

A mysterious patch of white hair on a young boy's scalp

March 01, 2007

A 5-year-old boy is referred to our clinic for evaluation of a patch of white hair on his right parietal scalp.
 

Enlarging growth alarms a young woman

December 01, 2006

A 23-year-old African-American woman presents with a growth on the right side of her groin area. She reports only minimal irritation but expresses significant concern over its enlarged size.
 

Dramatic signs with cranial nerve deficit

November 01, 2006

The patient, a 54-year-old-woman, presents to the dermatology office for evaluation of a possible skin infection on her left ear which has been ongoing for several weeks. She denies any fever or chills; however, she has noted occasional drainage from the ear. Ten years ago, the patient was treated for basal cell carcinoma (BCC), but she is in otherwise good health. Most recently she has been experiencing minimal left ear pain and difficulty hearing, as well as left-sided facial drooping.
 

Itch scratches at a multifaceted diagnosis

October 01, 2006

A 30-year-old Asian woman presents to our clinic with a very itchy rash on her neck that has been present for several months. She had attempted to relieve the itch with both OTC (eg, triple antibiotic ointment, clotrimazole cream) and prescription (desonide cream) treatments, none of which were effective.
 

Umbilical lesion appears in a woman with a history of sun exposure

September 01, 2006

A 26-year-old woman presents with a lesion in her umbilical area. The patient had never seen it before, so she assumed it was new. She had a history of excessive sun exposure, although it was fairly well tolerated. Her health was good in other respects, and there was no family history of skin cancer.
 

Melanoma scare prompts this patient to take a new look at an old lesion

August 01, 2006

A 58-year-old man presents to the dermatology department with a lesion on his right anterior shoulder. The lesion had been growing slowly but steadily for 20 years and had reached the point where activities such as bathing, dressing, and normal movement traumatized it regularly.
 

Persistent warts in an adolescent with severe atopy

July 01, 2006

A 16-year-old girl is referred to dermatology by her pediatrician for the removal of "warts" that have been present on her fingers for years. Many attempts at treatment, including use of OTC (salicylic-acid based) products and liquid nitrogen, have all been unsuccessful. Liquid nitrogen had debulked the warts temporarily, but they had grown back rather rapidly.
 

A common cause of photodistributed rash

June 01, 2006

A 57-year-old woman is referred to the dermatology clinic by her primary care provider for evaluation of an itchy rash that has been present on her chest, upper back, and the lower halves of her arms for the past 2 months. The rash, which frightened the patient, had persisted despite several short courses of prednisone and the application of several tubes of topical corticosteroid cream (triamcinolone 0.1%).
 

A common and deadly misunderstanding

May 01, 2006

A 54-year-old man was referred to the dermatology clinic for evaluation of a lesion on his neck. The lesion had been present for an indeterminate period of time but was now becoming irritated by clothing.
 

When the treatment becomes the problem

April 01, 2006

Infection" is a very attractive bandwagon onto which many clinicians climb. Take the case of a 62-year-old woman who had been suffering with an "infection" for more than 18 months despite numerous courses of antibiotics carefully prescribed to combat the different pathogenic microorganisms found on multiple cultures. The woman, who was otherwise reasonably healthy, complained of itching and burning in the intergluteal and perianal area, but her biggest complaint was constantly draining fluid—which she called "pus"—that necessitated changing pads several times a day. In addition to the oral antibiotics she had taken, the patient had applied a number of topical preparations, none of which had done the slightest bit of good.
 

The patient who feared she had “Michael Jackson’s disease”

March 01, 2006

A 54-year-old woman was referred to the dermatology clinic for evaluation of asymptomatic lesions on her arms and legs. The lesions had been present for several years and were growing slowly in number and intensity.
 

A condition that is more than skin deep

February 01, 2006

An 81-year-old man recently came to the dermatology department for evaluation of a leg rash. The lesions, which were minimally symptomatic, had been present for several weeks but had been growing in size and number despite treatment with antifungal and topical corticosteroid creams.
 
 

A case of scarring alopecia

Sven M. Hochheimer, MD, MPAS; Kimberly L. Maino, MD December 01, 2005

A 53-year-old white woman presents to the dermatology clinic for a refill on her ketoconazole 2% shampoo. About 1 year ago, her primary care provider had prescribed this antifungal shampoo for treatment of a pruritic, balding, tender area on her posterior scalp. The area has not improved since she started using the shampoo, but it also has not worsened.
 

Multiple “warts” on the lower legs of a 52-year-old woman

, Joe R. Monroe, PA-C, MPAS November 01, 2005

A 52-year-old woman presents with multiple lesions on her legs, which she calls warts. These have gradually appeared over the past 2 to 3 years. They have persisted despite the patient's use of a salicylic-acid-based OTC wart treatment and her primary care provider's use of liquid nitrogen. Her mother and one sibling have the same lesions. The patient is in good health otherwise.
 

A 63-year-old woman reports new changes in a long-standing “rash”

October 01, 2005

A 63-year-old woman presents with recent changes in a "rash" on her upper chest and neck that has been present for many years. The rash has become progressively redder and focally irritated. A lesion was "removed" from this area when the patient was a child, and the rash has been there ever since.
 

Think again about that pedicure

September 01, 2005

A 30-year-old white man presented to our dermatology clinic complaining of a 1-month history of painful sores on both lower legs. He had seen his primary care provider, who had said that he had a Staphylococcus aureus infection and treated him with a course of moxifloxacin, with no improvement.
 

An “infection” that antibiotics won’t cure

July 01, 2005

A 29-year-old woman presented to the dermatology clinic with what she called an "infection" on her anterior thigh. It had been present for 10 days and had not responded to oral and topical antibiotics, and it was getting worse.
 

Painless lesions and an odd biopsy result

June 01, 2005

A 41-year-old man presented with an 18-month history of asymptomatic macules on his central trunk. They had steadily increased in number, covering more and more area over time. The patient denied having been ill before the onset of the condition, had not taken
 

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