Grand Rounds Cases - Dermatology Grand Rounds

Two Brown Spots on the Left Hand

October 24, 2002

Presenter: Matthew Muellenhoff , DO, Thi Tran, DO, Frank Armstrong , DO, Kathleen Soe, DO, Greg Houck, DO, Marya Cassandra, DO

Dermatology Program: Sun Coast Hospital, NOVA Southeastern University Dermatology Program

CHIEF COMPLAINT: Two Brown Spots on the Left Hand

CLINICAL HISTORY: The patient reported a 5-year history of two brown spots on the left hand. Initially, the lesions were blue and attributed to ink stains although the patient denied contact with any staining chemicals or dyes. The “spots” increased in size over a two-year period and changed from blue to brown in color. She denied recent travel and had no history of skin cancer or atypical nevi. Family history revealed a brother with a history of melanoma. Her medications included premarin and glucosamine and she denied any allergies.

Pruritic Painful Groin Rash

September 29, 2002

Presenter: Laurie Schaeffer, D.O., Michael Eyre, D.O., Wendy McFalda, D.O., Cindy Lavery, D.O.

Dermatology Program: Pontiac Osteopathic Hospital

CHIEF COMPLAINT: Pruritic, painful groin rash for approximately six weeks

CLINICAL HISTORY: The patient experienced a painful, pruritic, and progressive rash located in the groin. The rash began on the sides of his scrotum and had steadily progressed to involve the entire scrotum, sides of the penis, and upper thighs. He had difficulty ambulating and washing the area due to the intense pain. He denied any dysuria, hematuria, or discharge. He could not recall similar outbreaks and denied any constitutional symptoms. He complained of occasional diarrhea.

Subcutaneous Nodules on the Face, Neck, and Upper Extremities

August 29, 2002

Presenter: Robert J. Zabel, DO

Dermatology Program: Philadelphia College of Osteopathic Medicine / Lehigh Valley Hospital

CHIEF COMPLAINT: Chest pain and shortness of breath

CLINICAL HISTORY: A 60-year-old Hispanic female with a two-year history of idiopathic crescentic glomerulonephritis presented with chest pain and shortness of breath. Cardiac ischemia was excluded from serial lab studies and intravenous heparin was started for a potential pulmonary embolism. On hospital day three, subcutaneous nodules were noted on her forehead. These nodules rapidly increased in size and number over a 24-48 hour period. They spread rapidly over the face, neck, upper trunk, and upper extremities. The subcutaneous nodules transitioned to exophytic and weeping lesions. On hospital day seven, she developed a productive cough with blood-tinged sputum and a chest radiograph showed diffuse bilateral infiltrates. A pulmonary angiogram was negative for an embolism and anticoagulation was stopped. A bronchoscopy revealed nodules lining the bronchi and diffuse alveolar hemorrhage.

Translucent and Hyperpigmented Papules and Nodules on the Upper Back and Neck

July 29, 2002

Presenter: Stephen Mallette DO, Alpesh Desai DO

Dermatology Program: Western University College of Osteopathic Medicine of the Pacific

CHIEF COMPLAINT: Painless papules on the upper back for three months, which are increasing in size and number.

CLINICAL HISTORY: The patient states that lesions are non-tender and have enlarged slowly over time. There is no pruritus or discharge from the lesions. They occur only on the upper back and neck. Topical steroids, topical antibiotic and oral antibiotics. The patient has been receiving dialysis since 1999 and has a fistula located on her left forearm. The patient moved to the United States from Nigeria in 1997.

Pruritic rash with alopecia

June 29, 2002

Presenter: Peter A. Vitulli, Jr. D.O., Steven Moreno, D.O., Eric Adelman, D.O.

Dermatology Program: Nova Southeastern University / North Broward Hospital District, Ft. Lauderdale, FL

CHIEF COMPLAINT: Pruritic Rash With Alopecia

CLINICAL HISTORY: A 78-year-old African American male presents to the dermatology clinic with a nine-year history of a progressively expanding, mildly pruritic rash on his neck and face. He reports that the eruption initially started on his neck and has since spread to involve his face. Additionally, he is experiencing progressive hair loss and a chronic cough, but he has not sought medical attention for these symptoms until now. His past medical history includes hypertension, and he has no significant past surgical history. He is allergic to penicillin. Family history is non-contributory, and socially, he lives with his wife and has two sons. He denies any use of tobacco or illicit drugs. In terms of previous treatment, he has not received any interventions for his skin condition. He is currently taking Adalat 30 mg daily for his hypertension.

Red nodule

May 29, 2002

Presenter: Debbbie Palmer, DO and Dimitria Papadopoulos, DO

Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York

CHIEF COMPLAINT: bilateral lower extremity edema and a growing red nodule

CLINICAL HISTORY: A 45-year-old Black male was presented from the nursing home with a one-week history of bilateral lower extremity edema and a few months of a nonpruritic, progressively enlarging growth on his left foot. This growth has bled with mild trauma. His past medical history is significant for HIV, endocarditis, cardiomegaly, congestive heart failure, intravenous drug abuse, end-stage renal disease, and pneumonia. The patient has not received any previous treatment for his current condition. His medication regimen includes methadone, temazepam, zolpidem, calcium carbonate, calcitriol, folic acid, a multivitamin, ferrous sulfate, and trimethoprim-sulfamethoxazole.

Lesion on Right Forehead

December 25, 2003

Presenter: Rick Lin DO MPH and Dan J Ladd DO

Dermatology Program: Kirksville College of Osteopathic Medicine Dermatology Department

CHIEF COMPLAINT: A spot on the right forehead

CLINICAL HISTORY: Patient with a history of basal cell carcinoma returned to clinic for a follow-up visit to be monitored for possible recurrence of Skin Cancer and to evaluate skin for the possible development of new pre-cancers. The patient was found to have a spot on his right forehead. He did not know how long the spot had been there. The lesion is asymptomatic.

Progressively Enlarging Papule

December 25, 2003

Presenter: Jocelyn E. Harris, DO

Dermatology Program: Lehigh Valley Hospital

CHIEF COMPLAINT: A progressively enlarging papule on the patient’s left cheek

CLINICAL HISTORY: Patient presented to clinic for a lesion with no discharge and was neither tender nor pruritic. She denied any history of similar lesions. She also denied fever, night sweats, heat/cold intolerance, and weight fluctuation. Upon initial presentation to her primary care physician, a diagnosis of an irritated epidermal cyst was made and she was prescribed three courses of azithromycin. Incision and drainage by her PCP failed to express any culturable material or cause the lesion to involute.

Generalized Pustules

November 25, 2003

Presenter: Peter Vitulli Jr. DO and Chris Manlio DO

Dermatology Program: North Broward Hospital District

CHIEF COMPLAINT: Fever, malaise, and a skin rash with suspected bacteremia

CLINICAL HISTORY: A 17-year-old Hispanic female was admitted to the hospital with fever, malaise, and a widespread skin rash suggestive of bacteremia. Initially, she experienced pruritus followed by burning pain in her skin, which worsened with movement. She reported a fever reaching 103.7°F, along with nausea, anorexia, and malaise. The patient had a history of psoriasis, previously controlled with mid- to high-potency topical steroids and Dovonex ointment. Approximately six days prior to admission, she was seen by her dermatologist for worsening psoriasis, presenting with multiple erythematous macules in the flexor areas and silvery plaques on the extensor surfaces of her elbows and knees. She was started on triamcinolone 0.1% cream and Dovonex ointment, both to be applied twice daily. Over the next six days, her rash spread extensively, leading to the formation of pustules and prompting her pediatrician to admit her to the hospital.

Disseminated Papules

August 31, 2003

Presenter: Igor Chaplik, D.O., Charles Gropper, M.D., Cindy Hoffman, D.O.

Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York

CHIEF COMPLAINT: Fever, cough, intermittent headaches, weakness, shortness of breath, and a twenty-pound weight loss over the last month.

Pearly Papule of the Ear

July 25, 2003

Presenter: Dan J. Ladd, DO, Rick Lin DO MPH

Dermatology Program: Texas Division of KCOM Dermatology Residency Program

CHIEF COMPLAINT: Lesion on the left ear that has been slowly growing x 1 year

CLINICAL HISTORY: A 74-year-old Caucasian male presents with a lesion on the left ear that has been slowly growing for 1 year. The lesion is asymptomatic, does not bleed or ulcerate, and has had no previous treatment.

Itchy, Dark Rash on Upper Back

May 30, 2003

Presenter: Suzanne Sirota Rozenberg, D.O.,Scott Goffin, D.O., Darren DiGulio, D.O., Yelva Lynfield, M.D., Marvin Watsky, D.O.

Dermatology Program: St. John’s Episcopal Hospital, Far Rockaway, New York

CHIEF COMPLAINT: Itchy, dark rash on upper back for 5 years

CLINICAL HISTORY: Patient presented to clinic with concerns of an itchy, dark rash on his upper back for 5 years. The patient states that he was treated in Yemen with unknown topical medications. He states that he had some resolution, but then had recurrences. The patient states that he has no prior history of trauma or previous biopsy. He has no significant past medical history or surgical history, no known allergies, and no medications at this time.

Rash on the Penis

November 25, 2004

Presenter: Matthew Muellenhoff , DO, Thi Tran, DO, Frank Armstrong , DO , Kathleen Soe, DO, Greg Houck, DO , Marya Cassandra, DO

Dermatology Program: Sun Coast Hospital, NOVA Southeastern University

CHIEF COMPLAINT: Rash on the Penis

CLINICAL HISTORY: A 58-year-old uncircumcised white male presented to our dermatology clinic for evaluation of a “rash” on his penis for >5 years. Past medical history was significant for hypertension, hyperlipidemia, and coronary artery disease. He had used over the counter products such as Gold-Bond ointment, Vaseline, and cortisone without benefit. Localized irritation with coitus, duration of the “rash” and concern of “what it is” brought him to our clinic.

Enlarging Skin Lesion Since Birth

September 25, 2004

Presenter: Dr. Suzanne Sirota Rozenberg, PGY3, Dr. Norma Montiel, PGY2

Dermatology Program: St. Johns Episcopal Hospital, South Shore, Far Rockaway, New York

CHIEF COMPLAINT: Enlarging skin lesion since the birth of the right forearm, wrist, and hand

CLINICAL HISTORY: A 1-month-old female presents with an enlarging skin lesion since the birth of the right forearm, wrist, and hand. The mother states that the lesion has been present since the baby was born and has been getting bigger. The child demonstrates a full range of motion of the arm, no crying, crankiness, or failure to thrive. No previous treatments. The patient was born prematurely at 35 weeks and demonstrated no postnatal complications.

Change in the Color and Texture of Hair

August 25, 2004

Presenter: Scott A. Smith, D.O.; Mary Veremis-Ley, D.O.; Michelle L. Endicott, D.O.; Melissa Camouse, D.O.; Mary A. Evers, D.O.

Dermatology Program: University Hospitals of Cleveland, Richmond Heights

CHIEF COMPLAINT: Change in hair texture and hair color

CLINICAL HISTORY: A 2-year-old girl presented to the clinic at the age of 11 months. She had a 4-month history of change in the color and texture of her hair. Per the patient’s mother, her hair had gradually gotten lighter, kinkier, and more difficult to comb. The mother denies any hair loss or breakage. The patient is otherwise healthy. Growth and development have been normal. The patient takes no medicines. The patient’s 1-year-old sister is now experiencing similar complaints. The patient’s great aunt had similar hair complaints as a child, which subsequently improved with her age.

Painful Lesions in the Mouth

July 25, 2004

Presenter: Scott C. Wickless, DO; Amy B. Cardellio, DO; Anthony Cardellio, DO

Dermatology Program: St. John Oakland Hospital

CHIEF COMPLAINT: Painful lesions in the mouth

CLINICAL HISTORY: Patient presented with mild to moderate pain of the mouth and tongue for approximately five years. Stated was semi-controlled with topical steroid and antifungal preparations. Patient also noted spots appearing sporadically on the scalp. No history of bone marrow transplant, hematopoietic stem cell transplantation, transfusion of irradiated blood products, or solid organ transplantation.

Sudden Onset of Disseminated Papules

April 25, 2004

Presenter: Charmaine Jensen DO, Rene Bermudez DO, Dimitry Palceski DO, Theresa Ng DO

Dermatology Program: Cuyahoga Falls General Hospital

CHIEF COMPLAINT: “Raised bumps all over my body”

CLINICAL HISTORY: A 40-year-old 120kg Caucasian male presented to our clinic with multiple, moderately pruritic yellow hard papules on his knees, thighs, buttocks, back, abdomen, and elbows. He had been in a hot tub two weeks prior to the onset of his lesions. The lesions appeared suddenly on his knees and elbows and subsequently spread to his abdomen, lower back, thighs, and buttocks. He presented to the emergency department and was diagnosed with molluscum contagiosum. He has treated these lesions with Retin-A cream and cryosurgery. No other family members are affected. He has a history of diabetes mellitus type 2 and had not been on his medications for several months because of financial constraints. He denied having any nausea, vomiting, or abdominal pain.

Enlarging Nodule on Right Middle Finger

March 25, 2004

Presenter: Valerie Johnson, D.O., Marya Cassandra, D.O., Greg Houck, D.O., Kristin Witfill, D.O., Matt Muellenhoff, D.O., Thi Tran, D.O.

Dermatology Program: Sun Coast Hospital (NOVA Southeastern University)

CHIEF COMPLAINT: Recurring and rapidly enlarging nodule on the right middle finger

CLINICAL HISTORY: A 7 month-old, healthy appearing, well-nourished male presented with a recurring and rapidly enlarging nodule on the right middle finger that parents stated was cosmetically disfiguring. The nodule had previously been excised by a hand surgeon when the patient was 2 months old. The mother was concerned about the recurrence and prognosis.

Intermittent Upper Body Eruption

February 25, 2004

Presenter: Megan Goff, DO

Dermatology Program: WUHS/COMP AZ Derm program

CHIEF COMPLAINT: Intermittent upper body eruption for several months

CLINICAL HISTORY: Patient presented to clinic with concerns of an intermittent, mildly pruritic upper body rash for several months. The patient believed it first appeared after a radiographic study with contrast for follow up of her metastatic breast carcinoma. The patient’s medical and surgical history was significant for left breast ductal carcinoma T1N0 status post modified radical mastectomy (8/86), metastasis to the mediastinum and retrocrural lymph nodes status post-chemotherapy completed 3/92, resection of left adrenal metastasis (10/92), and solitary brain metastasis, status post craniotomy, resection, X-ray therapy (10/96).

Skin Irritation of Arms, Face, Ears, and Legs

December 26, 2005

Presenter: JoAnne M. LaRow. D.O.

Dermatology Program: Northeast Regional Medical Center/KCOM

CHIEF COMPLAINT: Skin irritation of arms, face, ears, and legs of two weeks duration

CLINICAL HISTORY: Patient presented to our clinic for skin irritation first noted on her face that gets itchy when she is overheated. She also endorsed arthralgias and fatigue. Patient is post=partum 15 weeks and delivered twin girls via c-section 2/7/03. Her pregnancy was complicated by hypertension in the third trimester. After delivery, she was started on Lisinopril 20 mg QD (started April 2003). She initially saw her primary care provider for the facial eruption and was started on erythromycin 333mg orally three times a day for ten days. The patient completed this treatment four days prior to presentation to our office and was also applying triamcinolone 0.1# cream two to three times a day. She has noted progressive spreading to her arms, ears, and legs.

Diffuse Scaling over Trunk, Neck and Extremities

April 26, 2005

Presenter: Tara H. Lawlor, D.O.

Dermatology Program: Lehigh Valley Hospital-Muhlenberg/PCOM

CHIEF COMPLAINT: “Dry skin all my life”

CLINICAL HISTORY: Patient presented with concerns of dry skin and diffuse scaling on trunk, neck and extremities. He has tried over the counter emollients (Eucerin®). The patient has a nephew with similar skin findings. His birth history was unremarkable with no prolonged labor or failure to progress and he had no history of undescended testes. Urologic and ophthalmologic exams were both within normal limits.

Large, Itchy Bumps All Over the Body

January 25, 2005

Presenter: Nilam Amin DO PGY-3, Marcy Alvarez DO PGY-2, Raymond Ramirez DO PGY-2

Dermatology Program: New York United Medical Center, New York

CHIEF COMPLAINT: Large, Itchy Bumps All Over the Body x 3 days

CLINICAL HISTORY: 60 years old Hispanic male presented with with diffusely spread large, pruritic and painful bumps for three days. Denies burning, discharge, fever or other constitutional symptoms. Has tried topical corticosteroids, blinded biologic trial drug for psoriasis (name unknown), phototherapy, and etanercept (Enbrel®). This patient was diagnosed with chronic plaque psoriasis in 1989. He had been treated with multiple different regimens without significant improvement. Three months prior to his presenting complaint, he has treated with etanercept 25 mg SQ injections BIW. He discontinued etanercept after two months of treatment secondary to the complaint of severe headache. The patient presented to our clinic five months after discontinuation of the injectable biologic. He denies other psoriasis treatments between the time of discontinuation and the outbreak of his eruption. He denies household contacts with similar complaints, recent travel, or prior episodes of similar lesions.

Growth on the Left Foot

January 25, 2005

Presenter: Suleman Bangash, DO, and Carissa Summa, DO

Dermatology Program: New York United Medical Center, New York

CHIEF COMPLAINT: Growth on the Left Foot

CLINICAL HISTORY: Patient with Milroy’s disease (congenital lymphedema) presented with a new growth on left foot that was slightly tender to palpation. She reported that the lesion began as a brown patch and slowly enlarged to a dome-shaped nodule over several years. She also reported multiple similar, but smaller lesions on her upper and lower extremities and trunk. The patient was only taking Hydrochlorothiazide for the lower extremity edema.

Itchy Patches

October 26, 2006

Presenter: Tracy Favreau, DO; Asfa Akhtar, DO; Merrick Elias, DO; Kristen Aloupis, DO; David Bonney, DO; Brian Feinstein, DO; Chris Buckley, DO; Marcus Goodman, DO; Allison Schwedelson, DO

Dermatology Program: NSUCOM/NBHD

CHIEF COMPLAINT: intensely pruritic lesions

CLINICAL HISTORY: The patient is a 60-year-old Latin male presenting for evaluation of itchy patches in his bilateral axillae, inguinal region, and gluteal folds. The patient states this eruption is ongoing for the previous three months and is progressively worsening. Has not tried any topical or oral OTC or prescription medications to treat the lesions. He feels as if the lesions began after starting a new medication. He started taking Lipitor, Metformin, and Lotrel four months prior to the onset of lesions.

Painful, Swollen Left Foot

September 26, 2006

Presenter: Matthew Smetanick, D.O., Gregg Severs, D.O., J. Greg Brady, D.O.

Dermatology Program: Frankford Hospital/PCOM

CHIEF COMPLAINT: painful, swollen left foot following trauma

CLINICAL HISTORY: A 69-year-old, otherwise healthy woman was seen in our office for a painful, swollen left foot. She reported a two-week history of worsening symptoms after stepping on a sharp object while walking barefoot at home. The patient experienced pain at the base of her left first toe, but could not identify an obvious puncture wound or foreign body at the time of injury. Initially, the patient was seen at an urgent care center and was treated with prednisone for a suspected bite reaction on her toe. The patient was then seen five days later by her primary care physician and received cephalexin for suspected cellulitis. Her prednisone was also discontinued at that time. Her past medical history was significant for hypertension and hyperlipidemia. Medications included olmesartan, rosuvastatin, and a multivitamin. The patient admitted to having chills a few days prior to her presentation at our office. The patient was sent to the emergency room for cultures and radiographic studies. She was subsequently admitted and placed on empiric antibiotic therapy with clindamycin and vancomycin. The patient was also started on itraconazole to cover a possible fungal infection, pending tissue biopsy, and culture results.

Dyspnea, Hemoptysis, and Rash

July 26, 2006

Presenter: David B. Roy D.O.

Dermatology Program: Midwestern University of Health Sciences

CHIEF COMPLAINT: Sudden onset of dyspnea and cough with hemoptysis as well as a painful rash on face and legs

CLINICAL HISTORY: A 70-year-old white male with MI, tobacco use, hypertension, coronary artery disease, and a sedentary lifestyle presented to clinic complaining of a sudden onset of dyspnea and cough with hemoptysis as well as a painful rash on face, legs, perinasal area, and perioral area with ulceration. Patient also endorses congestion, hematuria, difficulty walking, and weakness. The patient had completed a course of PO prednisone approximately two months earlier due to an unspecified rash of the lower extremities.

Skin Rash on the Bilateral Upper Extremities and Face

July 26, 2006

Presenter: Jennifer Bucci, DO & Schield Wikas, DO, FACOD

Dermatology Program: Cuyahoga Falls General Hospital

CHIEF COMPLAINT: Rash on bilateral upper extremities and face for several months

CLINICAL HISTORY: This is a case of a 39-year-old Caucasian female who presented with a skin rash of several months duration on the bilateral upper extremities and face. She later developed many extracutaneous manifestations including xerostomia, dysphagia, fatigue, anorexia with subsequent weight loss, and paresthesias of the bilateral lower extremities. Most disconcerting to her, however, was an accelerating loss of motor function; she had difficulty getting out of a chair and walking upstairs. She has tried topical steroids for the rash without signs of improvement.

Progressive Worsening Rash

April 26, 2006

Presenter: Marya Cassandra, Greg Houck, Valerie Johnson, Kristin Witfill, Andrea Nelson, and Nanda Channaiah

Dermatology Program: Nova Southeastern University/Sun Coast Hospital

CHIEF COMPLAINT: Progressively worsening diffuse rash

CLINICAL HISTORY: Patient presented to clinic with a 5 year history of a progressively worsening rash on the face, trunk, and upper and lower extremities, including the palms and soles. This was previously diagnosed as vitiligo and eczema. Lesions were very pruritic and scaly in nature. Has tried Claritin, Atarax, Protopic, Salicylic acid and various topical steroids. No family history of a similar rash. No recent travels.

Facial mass

February 26, 2008

Presenter: Alice Do, DO, Brian Kopitzki, DO, Chris Buatti, DO

Dermatology Program: Genesys / Michigan State University

CHIEF COMPLAINT: Facial mass.

CLINICAL HISTORY: A 73-year-old Caucasian woman presented with a 20-year history of violaceous masses of the left periocular area and left chest that has waxed and waned. These lesions were asymptomatic. 10 years ago, the lesions were biopsied and diagnosed as a low-grade B cell lymphoma without systemic involvement, and no chemotherapy was indicated at that time. Over the years, the lesions continued to wax and wane, but recently, the lesions have gotten larger.

Pruritic plaques in the axillae

February 26, 2008

Presenter: Nicole Bright, DO, Sharon Zellis, DO, Tanya Ermolovich, DO

Dermatology Program: Philadelphia College of Osteopathic Medicine/Frankford Hospital

CHIEF COMPLAINT: Pruritic rash in the axillae

CLINICAL HISTORY: A 70-year-old female presents with several month histories of hyperpigmented pruritic lesions in bilateral axillae. No previous treatment history. Her past medical history is significant for arthritis, thyroid disease, diabetes, and hypertension. Her medications include pioglitazone, calcium, valsartan, and thyroid medication. She denies any changes in her soap or laundry detergent. The patient’s lesions persist despite the switching brand of deodorant. She denies dryer sheet usage but uses a scented fabric softener. She also has no known drug allergies.

Pruritic erythematous rash after sun exposure

January 26, 2008

Presenter: John P. Minni, DO and Dwayne D. Montie, DO

Dermatology Program: Columbia Hospital

CHIEF COMPLAINT: “My son gets a rash when he goes outside”

CLINICAL HISTORY: 7 yo male with several month histories of a pruritic red rash which occurs minutes to hours after sun exposure. Patient has tried topical low potency steroids without success. The patient’s mother later related that the patient suffers from frequent cold sores.

Persistent plaques after bone marrow transplant

September 26, 2007

Presenter: Risa Gorin, DO

Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York

CHIEF COMPLAINT: persistent rash for 7 years

CLINICAL HISTORY: A 19 yr old Hispanic male with a seven-year history of a persistent rash presented to our clinic. The lesions began on his proximal extremities and increased in number and size over time. The lesions began one year after allogeneic bone marrow transplant for acute myelogenous leukemia. However, he stated that he was not taking any immunosuppressants when the rash started. The lesions were occasionally pruritic and unresponsive to super-high potency topical steroids. Family history was non-contributory. Patient was not taking any medications at the time of presentation to our office.

Reddish-brown macules

August 26, 2007

Presenter: Andrea Costanza, DO, Nanda Channaiah, DO, Kevin Belasco, DO, Kevin Dehart, DO, Aaron Bruce, DO and Roger Sica, DO

Dermatology Program: NOVA Southeastern University – Suncoast Hospital

CHIEF COMPLAINT: Adolescent-onset rash and progressively worsening symptoms

CLINICAL HISTORY: We present a 25 y/o female with a history of adolescent-onset rash and progressively worsening symptoms. Upon review of history, the patient admitted to recurrent episodes of headaches, fainting spells, flushing, pruritus, palpitations, wheezing, abdominal pain, and vomiting within the last year. Her skin lesions periodically become raised, erythematous, and pruritic, which are exacerbated with “asthma attacks.” Exercise and Naprosyn worsen her symptoms and induce acute attacks. Neurocardiogenic syncope was also noted in medical history.

Painful nodules on the feet

August 26, 2007

Presenter: Kenneth T. Kircher, DO

Dermatology Program: Philadelphia College of Osteopathic Medicine / Lehigh Valley Hospital

CHIEF COMPLAINT: Painful Nodules on Plantar Aspects of Feet

CLINICAL HISTORY: A well-appearing 12-year-old girl presented to the office with exquisitely tender erythematous dermal to subcutaneous nodules on the plantar and lateral aspects of both feet. The patient states that she awoke two days ago with 1-2 slightly raised erythematous nodules on her right foot, that were very tender to walk on. By that afternoon, she had 4-6 lesions on the plantar and lateral sides of both feet. They had become increasingly tender and now prevent ambulation. She denies fever, chills, or other constitutional symptoms. She denies exposure to cold, new medications, any recent illness, or trauma although she did have a prolonged ballet recital the day before. No prior treatments.

Swollen, sore red eye

July 26, 2007

Presenter: Tom Mackey, DO; Christian Anderson, DO; Jason Barr, DO

Dermatology Program: AZ Desert Dermatology

CHIEF COMPLAINT: “swollen, sore red eye” x 3 weeks

CLINICAL HISTORY: A 64-year-old Caucasian female presents to our clinic complaining of a “swollen, sore red eye” for the past three weeks. In addition to her using over the counter topical antibiotics, her primary doctor placed her on ciprofloxacin 500mg PO QD, currently day 5. Both the patient and her primary doctor are concerned that her condition is worsening despite treatment. Her condition began as a suspected “bug bite” which has just grown to involve the entire eye. Part of the lesion had blistered and some oozing was noted, but no ulceration. The patient denied recent URI, fever, vision changes, ptosis, or photophobia. She described some scant AM discharge from her eye without purulence.

Unilateral hyperpigmented axillary eruption

May 26, 2007

Presenter: Risa Gorin, DO

Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York

CHIEF COMPLAINT: Unilateral Hyperpigmented Axillary Eruption

CLINICAL HISTORY: A 71-year-old Hispanic female with a past medical history of insulin-dependent diabetes, and left cerebral vascular accident was referred by her primary care physician for evaluation of a unilateral, hyperpigmented rash located in the right axilla. According to the patient the rash had been present for three weeks. She admitted to using copious amounts of deodorants in the area. The patient denied any symptoms of pruritus or burning. Prior to the presentation, she did not receive any treatment for her rash.

Retroauricular ulcer in a patient with a history of multiple skin cancers

September 26, 2008

Presenter: Tony Nakhla, D.O.

Dermatology Program: Western University/Pacific Hospital of Long Beach

CHIEF COMPLAINT: “I have a skin cancer behind my ear”

CLINICAL HISTORY: A 55-year-old white male who presented to our clinic with a 2-week history of a painful sore on the right postauricular region. No history of prior treatment. The patient has a past medical history of multiple non-melanoma skin cancers including five squamous cell carcinoma and six basal cell carcinomas, three of which required Mohs. He reports no other significant past medical history and is on no medications. He smokes approximately one pack per day. The patient has no medical insurance and was concerned with procedural costs. He was willing to pay for a complete excision but did not want to pay for a biopsy since due to his history, he was convinced it was another skin cancer which needed to be removed.

Blisters on arms and legs

August 26, 2008

Presenter: Aaron Bruce, D.O., Roger Sica, D.O., Lyubov Avshalumova, D.O., Johnny Gurgen, D.O., Risa Ross, D.O., Rachel Epstein, D.O., Jessica Flowers, D.O., David Judy, D.O.

Dermatology Program: Nova Southeastern, Largo Medical Center, Sun Coast Hospital

CHIEF COMPLAINT: “Blisters on arms and legs”

CLINICAL HISTORY: We present a 50 y/o Caucasian female with a new onset of blisters on her thighs, arms, and axilla. Pt has a known history of Churg-Strauss Syndrome and states that she developed these blisters while on a prednisone taper. Pt denies any previous history of skin disease. She does state that these blisters become very irritated and painful at times. Pt denies oral lesions and constitutional symptoms. She denies starting, changing dosages, and frequency of any medications.

Multiple excoriations and erosions of the extremities

August 9, 2008

Presenter: Jason Mazzurco, DO; David Cleaver, DO; Brian Stewart, DO: Brooke Bair, DO; Billie Casse, DO

Dermatology Program: St. Joseph Mercy Hospital Ann Arbor/MSUCOM

CHIEF COMPLAINT: “Itchy sores on hands and feet”

CLINICAL HISTORY: An 81-year-old white male with a significant past medical history of chronic renal failure, bladder cancer and hemochromatosis presented with a three to four-week history of “sores all over his body.” He complained of pruritus, scratching and picking at the lesions. He also complained of chronically decreased urine output and swelling in both feet. He had previously been treated with diphenhydramine and hydroxyzine with little improvement of pruritus or skin lesions. The rest of the review of systems was unremarkable. He has been on hemodialysis for approximately 5 years for which he has a fistula in his left arm for dialysis access and has no history of diabetes mellitus. His medications at presentation included tramadol, diclofenac, alprazolam, metoprolol, losartan, omeprazole, diphenhydramine, and hydroxyzine.

Large yellow plaque on the tongue

July 26, 2008

Presenter: Shaheen Oshtory, D.O., Charles Gropper, M.D., Cindy Hoffman, D.O.

Dermatology Program: Saint Barnabas Hospital

CHIEF COMPLAINT: “My tongue hurts”

CLINICAL HISTORY: A 75 y/o female was admitted to St. Barnabas Hospital for metastatic malignant ascites secondary to vaginal cancer. On admission, she also complained of pain on her tongue and of a large, yellow plaque that had been present for several months. She denied any previous treatment. Her past medical history was significant for DM, HTN, chronic LBP, osteoporosis, bladder incontinence, and vaginal Cancer. Her current medications included Alendronate, Nexium, Neurontin, Lisinopril, Reglan, Etoprolol, MS Contin, Oxybutynin, and Zocor.

Sores on both hands

June 26, 2008

Presenter: Michelle Foley, DO, Brett Bender, DO, Joe Schneider, DO, John Coppola, DO, Brad Neuenschwander, DO, Derrick Adams, DO

Dermatology Program: Michigan State University POH Medical Center / Botsford Hospital

CHIEF COMPLAINT: “Painful sores on both hands”

CLINICAL HISTORY: A 41 yo Caucasian male presented to our clinic with the above chief complaint stating the lesions began to develop after he sustained an abrasion to his right third finger while at work. He began to note multiple similar lesions developing shortly thereafter and was admitted to a local hospital for presumed cellulitis. Unable to tolerate IV vancomycin, he was started on a short course of oral antibiotics and was referred to our service by the infectious disease physician for an evaluation to rule out presumed pyoderma gangrenosum. Hospital treatment consisted of IV vancomycin and a oral course of Bactrim without improvement. A two-week course of topical fluocinonide 0.1% cream and cephalexin 500mg TID was also unsuccessful. No pertinent past medical history. Social history included a 1-2 pk/day tobacco use, occasional ETOH with a history of remote abuse, no illicit drug use, and no recent travel. Family history was unremarkable. Review of systems significant for three years unintentional thirty-pound weight loss. Due to a lack of medical insurance, this had not been investigated previously.

Excess skin on hand and foot

June 26, 2008

Presenter: Reagan Anderson, DO

Dermatology Program: Oakwood Southshore Medical Center

CHIEF COMPLAINT: 6-year-old white female presents to the clinic with masses on left jaw, right hand, and left ankle which have been progressively and symmetrically enlarging for the last 4 years.

CLINICAL HISTORY: Patient presents to our clinic, now at 6 years of age, with concerns that the masses of tissue on the left jaw, right hand, and left ankle have been proportionately growing with child’s age. She is asymptomatic and lesions do not interfere with daily life except for having to buy different sized shoes. So far, cheek and tongue lesions do not interfere with eating or swallowing and do not increase in size when illnesses are present.The patient was initially seen by multiple providers for “excess skin” on her right hand and left foot. Consultation at 3 years of age to Genetic and Metabolic Disorders at the Detroit Medical Center by Orthopedics was not conclusive but a diagnosis of neurofibromatosis (NF) type 1 was entertained. MRI of the left foot was performed at 3 years of age which was read as a likely venous or lymphatic structure. Follow-up with ultrasound was recommended by radiology but not performed. The patient was sent to Ophthalmology and had a normal examination.

Multiple ulcerations and erosions on the dorsal aspects of hands

May 26, 2008

Presenter: Keoni Nguyen, DO; Dawn Sammons, DO; Ramona Nixon, DO; Shannon Campbell, DO

Dermatology Program: Ohio University COM/ O’Bleness Memorial Hospital

CHIEF COMPLAINT: Irritation to the bilateral forearms, hands, neck, and face

CLINICAL HISTORY: A 38-year-old Caucasian male presented to our office with a one-year history of chronic blisters and non-healing ulcers on both of his upper extremities. His neck and face would incur a pruritic rash with prolong exposure to the sun. His symptoms are worse in the summer. The patient was previously treated with oral prednisone for ten days and an unknown topical cream; neither of which alleviated his symptoms. He denies any fevers, chills, or general myalgias. He reports a history of warts and seasonal allergies. He also endorses consuming 4-5 beers per night and 12 on the weekends and tobacco use of 1 pack per day. He works as an electrician. He had been to several countries outside of the U.S. in the past, while in the military. Denies any allergies to medications.

Atypical rash on the right forearm

May 26, 2008

Presenter: Lawrence A. Schiffman, D.O.

Dermatology Program: St. John’s Episcopal Hospital, South Shore, Far Rockaway, NY

CHIEF COMPLAINT: worsening rash of right arm

CLINICAL HISTORY: A 28-year-old man presents to the office for evaluation of a rash on his right arm. He reported an expanding rash on the right forearm during the previous 8 weeks. He complained of tenderness, itch, and yellow, pus-like discharge. He denied any antecedent trauma or insect bites. He also denied systemic symptoms such as fever, chills, myalgias or arthralgias. Three weeks earlier, he had seen his primary physician who had given him topical halobetasol 0.05% (Ultravate), oral prednisone, and ciprofloxacin. He was unsure of the dosage, but reported worsening of the condition, and stopped using the prescribed therapy. He stated that he was otherwise healthy and did not take any other medications. He had no known drug allergies. His family history was significant for Diabetes mellitus type II in his father. He drank alcohol socially and did not smoke. Interestingly, he worked as a sandblaster!

Asymptomatic fibrotic lesion on the mid back

April 26, 2008

Presenter: Patrick Keehan, D.O.

Dermatology Program: K.C.O.M. – Texas Division

CHIEF COMPLAINT: eight-year-old asymptomatic lesion on the back that was biopsied, leaving a non-healing ulcer

CLINICAL HISTORY: Our patient was 63-year-old caucasian man who presented to us in June 2006 for evaluation of an eight-year-old asymptomatic lesion on the back. He denied a history of radiation exposure or any trauma. There was a questionable history of a spider bite. A prior biopsy taken by another dermatologist during 2005 left a crusted non-healing ulceration. No resolution or improvement with topical steroids. The patient was switched to tacrolimus ointment twice daily and NbUVb three times weekly without improvement. Due to the complexity of the lesion, the patient’s history was reviewed again. Review of the past medical history revealed extensive coronary artery disease, AAA, Diabetes Mellitus Type II, GERD, HTN, and hypercholesterolemia.

Pruritic annular plaques

March 31, 2008

Presenter: Wade Keller, DO

Dermatology Program: Kingman Regional Medical Center/Midwestern University

CHIEF COMPLAINT: Pruritic rash to both arms and upper back

CLINICAL HISTORY: A 79-year-old female presented with a 2 weeks history of a progressively worsening pruritic rash that began on her right upper arm then the left arm and upper back. She is not sure if light makes the rash worse. She denies any changes in her medications with the exception of the addition of lisinopril three months ago. No previous treatmetns. Current medications include Lisinopril, Lipitor, Pacerone, Timolol, Aspirin, Xalantin, and Timoptic.

3 year-old with poor hair growth

April 26, 2010

Presenter: Kate Chilek, DO

Dermatology Program: Ohio University/O’Bleness Memorial Hospital

CHIEF COMPLAINT: “poor hair growth.”

CLINICAL HISTORY: 3-year-old female presented for the evaluation of “poor hair growth.” She was born with the dark blonde scalp hair, which fell out by 3 months of age. She re-grew some hair, but it was never substantial. Otherwise healthy, with normal growth and development. No history of prior treatments. The patient’s younger brother appears to have similar conditions but has not been diagnosed. No known familial disorders. Parents are unrelated.

Perioral and genital lesions

March 26, 2010

Presenter: Chris Weyer, DO; Bo Rivera, DO; Jonathan Cleaver, DO

Dermatology Program: Northeast Regional Medical Center – Kirksville

CHIEF COMPLAINT: oral and genital lesions

CLINICAL HISTORY: A 27-year-old female presents with a history of perioral lesions lasting at least one year and genital lesions persisting for over three years. She describes the genital lesions as itchy and burning, noting that they can bleed with excessive picking. Additionally, she reports experiencing burning sensations and increased frequency of urination. Despite recent normal pap smears, her symptoms have been concerning. Upon further questioning, the patient revealed a notable decrease in sweating. She has not received any prior treatments for her symptoms.

Pruritic rash involving upper torso and extremities

February 26, 2010

Presenter: Scott Deckelbaum, DO

Dermatology Program: Western University/Pacific Hospital

CHIEF COMPLAINT: progressively worsening diffuse pruritic rash

CLINICALHISTORY: 24-year-old Hispanic male with a complaint of a pruritic rash involving his upper torso and extremities. His symptoms have been slowly progressing over a 5 year period. Our patient reported diffuse pruritus without pain. His complete review of systems was otherwise negative including the presence of palpable masses. No prior treatments. Past Medical, Family and Social History were noncontributory. He immigrated from Mexico around 10 years prior and has no significant employment history.

Rash on lower extremities

January 26, 2010

Presenter: Susun Bellew, DO; Grace K. Kim, DO; Saira Momin, DO; Brent Michaels DO

Dermatology Program: Valley Hospital Medical Center, Las Vegas, Nevada

CHIEF COMPLAINT: “rash” on lower extremities

CLINICALHISTORY: A 62-year-old Italian man presented to the office for evaluation of a “rash” that started on his lower extremities. The patient reports a persistent eruption for 4 years that originally started on his lower extremities which progressed to his arm, palms, and low back. He also reported occasional pruritus of the lesions which was not severe. The patient and his wife both denied any suspected precipitating factors. He also denied constitutional symptoms such as fever, chills, weight loss, myalgia, or arthralgia. The lesions were previously treated with topical triamcinolone 0.1% cream with no clinical improvement. Past medical history was significant only for Parkinson’s disease. There was no known history of other major medical disorders, such as metabolic diseases or malignancies. He also denied recent travel or history of any sexually transmitted diseases, including syphilis. No other family members or close personal contacts were afflicted with similar lesions.

Non pruritic erythematous patch

January 26, 2010

Presenter: Amy D Adams, DO – PGY3

Dermatology Program: Midwestern University / Arizona Desert Dermatology – Kingman, AZ

CHIEF COMPLAINT: “Eczema spot that won’t go away”

CLINICAL HISTORY: 62 year old Caucasian female presented with nonpruritic erythematous patch on the patient’s right buttock that has been present for at least four years and was previously diagnosed and treated as Eczema. Reports minimal change over the last four years with no period of clearance. Previously has tried Topical antifungal creams, Class I-VI topical corticosteroids, and an intramuscular Triamcinolone injection. Pt reports slight benefit from the topical combination of Nystatin / Triamcinolone but denies any benefit from the other medications. Pt works in a daycare center. She is not taking oral prescription medications or herbal supplements.

Darkish discoloration of skin involving the back, neck, and upper arms

December 26, 2009

Presenter: Christopher Buckley, DO; Marcus Goodman, DO; Allison Schwedelson, DO; Angela Combs, DO; Matthew Elias, DO; Emily Rubenstein, DO; Carlos Gomez-Meade, DO; Julian Moore, DO; Rupa Reddy, DO

Dermatology Program: NSUCOM/Broward General Medical Center

CHIEF COMPLAINT: darkish discoloration of skin ongoing for several years.

CLINICAL HISTORY: 58-year-old Hispanic male with HTN (not on medication) presented with darkish discoloration of skin involving the back, neck, and upper arms. The discoloration was ongoing for several years. No associated pruritus, pain, or previous skin lesions. No new medications. No prior treatments.

Itchy brown patch on left axilla

October 26, 2009

Presenter: Krina Chavda, D.O., Suzanne Sirota Rozenberg, D.O.

Dermatology Program: St. Johns Episcopal Hospital, Far Rockaway, NY

CHIEF COMPLAINT: Itchy brown patch on left axilla.

CLINICAL HISTORY: A 6 year old African American male presented to our clinic with the above chief complaint. As per his father, the patient developed this patch approximately 4 to 5 months prior to his visit to us. He states that it recently started increasing in size. No prior treatment. The patient was on Trileptal for seizure disorder. He also had recently developed flaccid paraparesis for which he had an appointment scheduled for a Pediatric neurologist.

Soft asymptomatic lesion on the back

June 26, 2011

Presenter: Jonathan Cleaver D.O., Peter Knabel D.O

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: Soft asymptomatic lesion on the upper mid-back

CLINICAL HISTORY: A 16-year-old well developed female presents to the clinic for evaluation of a lesion on her back that has been present since she was an infant. The lesion has continued to increase in size as she has developed. The lesion is asymptomatic and the patient denies tenderness, drainage, bleeding, or color change. No one else in the family has a similar lesion. She has been healthy since birth and there is no significant family medical history reported. The patient is on no medication. The lesion has been manipulated by the mother multiple times trying to express material from the lesion. She has been unsuccessful at these attempts.

Violaceous nodule of the upper extremity

May 26, 2011

Presenter: Helen Kaporis, D.O.

Dermatology Program: KCOM- Texas Division

CHIEF COMPLAINT: Nodule of 6 months duration

CLINICAL HISTORY: Patient presented with an asymptomatic nodule of 6 months duration. No prior history of treatments to the lesion.

Patchy alopecia

February 26, 2011

Presenter: Stacy Rosenblum, D.O, Amanda Beehler, D.O. Amy Spizuoco D.O. Mariel Bird, D.O.

Dermatology Program: LECOMT/Alta Dermatology

CHIEF COMPLAINT: “Bald spots on scalp”

CLINICAL HISTORY: A 32-year-old Caucasian male presented with a progressive, one-month history of hair loss in patches. He denied loss of hair anywhere else on his body or any other skin lesions. He was otherwise healthy and had no significant past medical history or history of major medical illness in his family. He had been seen by his primary care physician and was using Nystatin once a day for 4-5 days with no improvement. He is married, and denied the use of tobacco or alcohol. Upon further questioning, the patient did admit to extramarital relations.

Pearly, pink protuberant tumor on the upper extremity

January 26, 2011

Presenter: Joseph Del Priore, DO
Dermatology Program: Western University/ Pacific Hospital
Program Director: David C. Horowitz, DO FACD
Submitted on: January 21, 2011

CHIEF COMPLAINT: Bump on arm

CLINICAL HISTORY: A 19-year-old male presented with a pink, shiny 3 cm protuberant nodule on his right upper extremity that grew rapidly over 2 months. A previous treatment of tea tree oil was tried.

Progressive hyperpigmented patches

December 26, 2010

Presenter: Zaina Rashid DO

Dermatology Program: Midwestern University/ Arizona Desert Dermatology

CHIEF COMPLAINT: Brown patch in both armpits for three months

CLINICAL HISTORY: A 73-year-old man presented with asymptomatic dark brown patches in the axillary area for 3 months duration. No previous treatment. There was no history of prolonged sun exposure or trauma in that area. The patient denied any symptoms of pain or pruritus. The patient past medical history includes hypertension with atenolol being his only medication.

Rash in nursing home patient

November 26, 2010

Presenter: Panagiotis Mitropoulos DO, Justin Rubin DO, Lise Brown DO, Stanley Skopit DO

Dermatology Program: NSU-COM/BGMC

CHIEF COMPLAINT: Rash on buttocks for several months

CLINICAL HISTORY: An 84-year-old Caucasian woman, nursing home resident, with a seven-month history of erythematous, mildly pruritic, non-tender rash involving the right buttock area. Patient was being treated by a primary care physician with ketoconazole cream without significant improvement of symptoms.

Enlarging erythematous plaque with multiple draining sinus tracts

October 26, 2010

Presenter: Ryan Jawitz, DO

Dermatology Program: St. Joseph Mercy Hospital

CHIEF COMPLAINT: “Rash on the right hand”

CLINICAL HISTORY: A 78-year-old male presented with a 2-month history of an erythematous plaque on his right hand that started after gardening. The plaque was non-pruritic and non-painful but has been draining a purulent discharge for the last six weeks. His medical history included diabetes mellitus type 2, coronary artery disease, chronic obstructive pulmonary disease, hypertension, prostate cancer, and laryngeal cancer treated with radiation. The plaque was treated as cellulitis with both oral and IV antibiotics for the prior two months, however, it continued to enlarge.

Persistent and progressive hyperpigmented patches

September 26, 2010

Presenter: Angela Bookout, DO; Lana McKinley, DO; Khonnie Wongkittiroch, DO

Dermatology Program: Largo Medical Center/ NOVA Southeastern University COM

CHIEF COMPLAINT: “Darkening of the skin for four years”

CLINICAL HISTORY: A 33-year-old Indian male complained of progressive darkening of his skin beginning on his neck, spreading to his face, and eventually involving both arms over the past 4 years. No previous treatments. He has no significant past medical history and no known drug allergies. He denied using oral medications or topical preparations during the past five years. He reported only incidental sun exposure. Review of systems was negative for pain, xerosis, pruritus, dermatitis, alopecia, nail changes, or other systemic symptoms.

Painful, erythematous-violaceous plaques across the abdomen

August 26, 2010

Presenter: Betsy Leveritt, DO

Dermatology Program: Wellington Regional Medical Center

CHIEF COMPLAINT: diffuse painful plaques

CLINICAL HISTORY: A 52-year-old Caucasian male with a past medical history of liver cirrhosis, subsequent hepatorenal syndrome, and end-stage renal disease (ESRD) on hemodialysis (HD), presented with a several month histories of numerous painful, erythematous-violaceous plaques across the abdomen and bilateral thighs and upper extremities, accompanied by necrotic erosions of the lower extremities. A review of systems revealed low-grade fevers with occasional chills, night sweats, and a significant weight loss of at least 13.6 kg over the preceding 3-4 months. During prior hospital admission, the patient manifested these same skin lesions, and was given a 3-month course of intravenous antibiotics for a biopsy-proven Actinomyces infection. He also recalled being given Heparin during that same hospital stay.

Rash in hospitalized patient

July 26, 2010

Presenter: Jonathan Richey, DO, Monica Nafsou, DO

Dermatology Program: Pontiac/Botsford Osteopathic Hospital

CHIEF COMPLAINT: “Red, painful rash on butt and armpits”

CLINICAL HISTORY: A 44-year-old Caucasian male with a history of lower extremity osteomyelitis was treated with Unasyn and Vancomycin following below the knee amputation. The patient had no prior medical history, largely due to inadequate health maintenance. He had a 20-pack year history of smoking. On the eighth day of treatment with antibiotics after amputation, the patient developed a “rash.” The patient described the lesions as “very painful” – the worst areas being the right axilla and sacral area.

Painful eyrthematous papules

June 26, 2010

Presenter: Chris Buatti D.O.

Dermatology Program: Genesys Regional Medical Center

CHIEF COMPLAINT: new-onset acne-like lesions on his face

CLINICALHISTORY: A 48-year-old African American male presented with new-onset acne-like lesions on his face. These erythematous painful papules started two months prior, and the patient complained primarily of pruritis. He was recently diagnosed with HIV after being hospitalized for pneumonia last June. His PCP started him on antiretrovirals, and Bactrim. He also denied constitutional symptoms such as fever, chills, weight loss, myalgias, or arthralgia. No prior treatments.

Chronic facial ulcers

May 1, 2010

Presenter: Brent Loftis, DO, Monica Nafsou, DO

Dermatology Program: Dermatology Program: A.T. Still University, KCOM Dermatology Residency Program, TX Division

CHIEF COMPLAINT: “Sores spreading on the face that started with shingles four years ago”

CLINICAL HISTORY: A 65-year-old Caucasian female with a four-year history of sores that started on the face after shingles. The sores have enlarged over the past few years and she feels the disease is spreading down towards the chest. As a retired physician, she has done excisional biopsies on herself and admits to using a scalpel on a regular basis to incise and drain the lesions, which gives her immense relief from the pressure of the lesions. She describes white tendon-like larvae and botfly-like larvae that come out and wrap around her scalpel.

Pruritic, purple plaques on the legs and axilla

June 26, 2012

Presenter: Katherine Johnson, D.O.

Dermatology Program: Botsford Hospital

CHIEF COMPLAINT: lower extremity swelling, pruritis, and pain

CLINICAL HISTORY: A 67-year-old Caucasian male presented to the clinic with a chief complaint of lower extremity swelling, pruritus, and pain. He also complained of discoloration of his lower extremities, right arm, and axillae, stating that one of his feet was “turning black”. Over a one-month duration, the patient noticed dark patches developing on his lower extremities, right upper extremity, and axillae. There was associated edema in his lower extremities accompanied by pain and pruritus. The patient visited urgent care, an emergency room, and his podiatrist for the chief complaint. Laboratory studies, radiographs, and an EKG were all found to be normal. The patient’s past medical history included renal transplantation in October 2010, and was maintained on mycophenolate mofetil 1g PO BID, tacrolimus 3mg PO BID, and prednisone 10 mg PO daily. Pertinent family medical history included a brother who was deceased due to malignant melanoma found in the axillae.

Tender plaques of the trunk

June 26, 2012

Presenter: Jonathan Cleaver DO, Cathy Koger DO, Peter Knabel DO, Stephen Plumb DO

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: tender and irritated plaque that drains

CLINICAL HISTORY: A 37-year-old Caucasian male presented with a 1-year history of a tender and irritated plaque that would drain fluid located on the left anterior shoulder that drains clear fluid. No previous therapy.

Hyperpigmented blistering lesion in a 13 yo female

May 26, 2012

Presenter: Michael Kassardjian, Helia Eragi, Teresa Ishak

Dermatology Program: Western University/Pacific Hospital Long Beach

CHIEF COMPLAINT: Painful blistering rash on the body

CLINICAL HISTORY: 13 YO Caucasian female had recently arranged a spa day where each individual laid out in the sun after applying lemon juice and other citrus plants/fruits to their body. Few hours after the sun exposure, the patient started experiencing pain erythematous rash on sun-exposed areas as mentioned with sparse blisters. No past medical history, no family history, patient otherwise healthy. No systemic symptoms.

Generalized rash

March 26, 2012

Presenter: Chelsea Lee, DO, Payal Patel, DO, Kimball Silverton, DO

Dermatology Program: Genesys Regional Medical Center

CHIEF COMPLAINT: rash located over her back, chest, neck, face, upper and lower extremities for two weeks

CLINICAL HISTORY: A 71-year-old woman presented to the dermatology clinic with a rash located over her back, chest, neck, face, upper and lower extremities for the duration of two weeks. The symptoms included stinging and pruritus. Her past medical history was significant for hypertension and GERD. She had never experienced a rash similar to this in the past, and she denied any recent changes in her health or lengthy exposure to sunlight. In addition, she denied any fevers, joint pains, a history of skin disease, or photosensitivity. The patient did, however, state that she began terbinafine for the treatment of onychomycosis two weeks prior to the development of the rash.

Multiple friable nodules on back

January 26, 2012

Presenter: Jackie Levin D.O., Ralph Fiore D.O., and Ellecia Cook D.O.

Dermatology Program: Largo Medical Center

CHIEF COMPLAINT: Bumps on back

CLINICAL HISTORY: Patient presented with bumps on his mid to lower back for the past two years. The lesions are painful, draining, and worsening. The lesions were recently incised and drained by primary care provider, and patient was using oral and topical antibiotics. Past medical history significant for hidradenitis suppurativa of the axillae, inguinal, and perianal region in which surgical excision was performed.

Hyperkeratotic plaques on the lower extremities

December 26, 2011

Presenter: Heather Orkwis, DO

Dermatology Program: St. Joseph Mercy Hospital

CHIEF COMPLAINT: greater-than-10-year history of dark, itchy spots on legs.

CLINICAL HISTORY: A 44-year-old woman presented with a greater-than-10-year history of dark, itchy spots on legs. She complained of pruritic, progressively worsening dark spots on the bilateral anterior lower legs. She used a bleaching cream on the areas 8 years prior without improvement. The patient has insulin resistance, hypertension, and arthritis.

Enlarging growth on the foot of a teenage boy

June 26, 2013

Presenter: Holly Kanavy, DO

Dermatology Program: St. Barnabas Hospital

CHIEF COMPLAINT: growth on the bottom of his left foot

CLINICAL HISTORY: 14 yo Caucasian male presented with growth on the bottom of his left foot for 3-4 months. He also endorses pain with ambulation. Previously, he had a series of curettages by podiatry, however the lesion continued to enlarge. Patient has a history of chronic macrocytosis and reticulocytopenia (bone marrow biopsy at age 10 revealed a non-clonal chromosome 15 deletion: 45 XY del(15)(q11.2)), developmental abnormalities, and Autism / Asperger’s disease.

Atypical vascular lesion arising in an area of previous radiation treatment on the breast

June 26, 2013

Presenter: Christian W. Oram, D.O.

Dermatology Program: Lehigh Valley Health Network/Philadelphia College of Osteopathic Medicine

CHIEF COMPLAINT: Lesion on the right breast

CLINICAL HISTORY: The patient presented in October 2010 with a pink to purple asymptomatic plaque on the right medial breast. The lesion had developed in an area of previous radiation treatment for breast cancer. Since the lesion arose in an area of previous radiation treatment, a biopsy was obtained. The lesion remained asymptomatic and stable in size for approximately one year. No treatment was pursued and watchful waiting was implemented, with the intent to biopsy any new or changing areas. At approximately twelve months, within the span of two weeks, the lesion grew four times in size and became tender. This prompted re-biopsy due to the aggressive clinical nature of the lesion.

Axillary pigmented papule in African-American

May 26, 2013

Presenter: Emily Kate Matthews, D.O.

Dermatology Program: PBCGME

CHIEF COMPLAINT: axillary pigmented papule

CLINICAL HISTORY: Patient presented with an enlarging pigmented papule of left axilla and chronic headaches. Multiple BCCs on the face and neck were surgically excised. A history of odontogenic keratocysts at age 15.

Dry and itchy skin for four and half months

April 26, 2013

Presenter: Vienna Lowenbraun, D.O.

Dermatology Program: Genesys

CHIEF COMPLAINT: diffusely “dry and itchy” skin.

CLINICAL HISTORY: A 74-year-old Caucasian male presented with complaint of four and a half months of diffusely “dry and itchy” skin. He noted that the skin changes began suddenly; first noticing the dryness on his arms, and within several days notice that it had become diffuse. He stated that he first noticed the changes two weeks after using a degreasing agent to clean his refrigerator coils and was concerned that the solvent was the source of his xerotic and pruritic skin. Several weeks prior to presenting to our clinic, he sought care at his primary care physician’s office for the same complaints. His primary care physician diagnosed him with having xerosis and was advised to apply Aquaphor twice daily.

Woman with red brown bumps on thighs and back

April 26, 2013

Presenter: Hamblin, T., DO; Brindise, R., DO; Laffer, M., OMS-IV; Grekin, S., DO

Dermatology Program: Oakwood Southshore Medical Center

CHIEF COMPLAINT: pruritic “sun spots” on both lower extremities

CLINICAL HISTORY: A 33-year-old Caucasian woman noticed in 1999 the appearance of pruritic “sun spots” on both lower extremities. She associated the appearance of the lesions with taking antibiotics that she received for strep pharyngitis. She did not remember the name of the antibiotics but did recall that the packaging specified the need for sun avoidance while taking them. She was, however, exposed to several hours of sun each day while vacationing during this time, and noticed the development of the lesions within one week of being on the medication. She subsequently presented to our clinic in June of 2007. She notes that she consulted dermatology out of curiosity regarding the lesions as well as for guidance regarding the severe pruritus associated with them. She noted that the pruritus was much worse with activity and in the winter season, but improved when the involved areas were exposed to sunlight. Review of systems was negative for flushing, lightheadedness, dizziness, anaphylaxis, nausea, vomiting, diarrhea, and bone or muscle pain. The patient’s medical history was unremarkable. Family history was negative for any chronic cutaneous disorders or other related findings.

Enlarging tumor on the finger

April 26, 2013

Presenter: Sean Branch, DO., Tanya Ermolovich, DO, Filomena Scola, DO

Dermatology Program: Lehigh Valley Hospital/PCOM

CHIEF COMPLAINT: Enlarging lesion on the 3rd digit of her right hand for approximately three years

CLINICAL HISTORY: Patient presented with an enlarging lesion on the third digit of her right hand that has been there for approximately three years. The patient states the lesion is otherwise asymptomatic. She has tried topical 17% salicylic acid for three weeks then discontinued due to significant irritation and bleeding.

Expanding facial mass in an elderly woman

March 26, 2013

Presenter: Peter Knabel DO, Cathy Koger DO, Stephen Plumb DO, Chris Cook DO

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: rapidly expanding, exophytic, painful ulceration on her left cheek.

CLINICAL HISTORY: The patient is an 85-year-old Caucasian female who presented with a rapidly expanding, exophytic, painful ulceration on her left cheek. The lesion is a friable, tender, erythematous nodule that had rapidly grown in the previous 6 months. No previous treatment. The patient resides in an assisted living facility, and they had provided symptomatic relief for her as needed. The patient has a past medical history consistent with sick sinus syndrome, rheumatoid arthritis, mild depression, and hypertension. She has no personal history of skin cancer or skin disorders. Her family history included a father that died of pancreatic cancer and a brother of unknown malignancy. She has never smoked or abused alcohol and has no known risk factors for sexually transmitted diseases.

New onset of cough

February 26, 2013

Presenter: Jennifer DePry DO, Kurt Lu MD

Dermatology Program: University Hospitals Richmond Medical Center

CHIEF COMPLAINT: Dry cough for greater than one month

CLINICAL HISTORY: 67-year-old Caucasian male with a past medical history significant for multiple basal cell carcinomas who presents with new-onset cough. Surgical excisions of multiple basal cell carcinomas including an aggressive one involving the underlying bone with perineural, and vascular invasion. This tumor required radiation and multiple surgeries, the last one in 2007, that resulted in the sacrifice of the distal branches of cranial nerve VII, a parotidectomy as well as fat and nerve grafts.

Eruption of hyperkeratotic, verrucous papules

January 26, 2013

Presenter: Michael Centilli, DO

Dermatology Program: Botsford/McLaren Oakland

CHIEF COMPLAINT: A generalized eruption of hyperkeratotic, verrucous papules

CLINICAL HISTORY: 57-year-old Caucasian female presented with a chief complaint of an 8-month history of a generalized eruption of hyperkeratotic, verrucous papules beginning in her left axilla with subsequent spread to her back, trunk, face, and all four extremities. Review of systems was positive for extensive pruritis and mild dysphagia with solid food. Prior to our consultation the patient had tried multiple therapies administered by several dermatologists, including cryotherapy, intralesional injection of 0.1 cc of candida antigen, the patient did not return for serial injections, and topical salicylic acid resulting in second-degree burns. Past medical history was positive for basal cell carcinoma of the left lower thigh, an abnormal pap smear of undetermined significance, a benign mass of the right breast, and breast augmentation. HIV testing had been performed in the past year and was negative.

Red-brown nodules on the lower extremities of a 74-year old female

January 26, 2013

Presenter: Leela Athalye DO, Michael Kassardjian DO

Dermatology Program: Western University/Pacific Hospital of Long Beach

CHIEF COMPLAINT: Painful and swollen lesions of left lower extremity

CLINICAL HISTORY: A 5-month history of painful lesions on the left lower leg. Prior to the appearance of lesions, the patient had noted numbness and burning of the left lower extremity. The patient denied systemic symptoms. No relevant prior medical history or family history. No previous treatments.

Persistent pyogenic scalp infection in a child

October 26, 2012

Presenter: Jared Heaton D.O., Brooke Walls D.O., Julian M. Ngo D.O.

Dermatology Program: NSUCOM/Largo Medical Center

CHIEF COMPLAINT: recurrent malodorous infection of the scalp

CLINICAL HISTORY: 5 y/o AA female presented for evaluation of recurrent malodorous infection of the scalp. This patient has a history of recurrent bacterial and fungal infections of the scalp for the past two to three years. She was recently admitted to All Children’s Hospital for pyoderma of the scalp secondary to MRSA where she was treated with IV antibiotics and surgical debridement. She had a previous surgical debridement of the scalp 1 year ago for the same condition recalcitrant to oral and topical medications. Several weeks after her most recent discharge from the hospital, the patient again developed a large fungating verrucous plaque of the scalp. Surgical debridement of the scalp secondary to pyoderma was performed in June 2012 and April 2011.

A 3-year old female with asymptomatic scalp hair loss

October 26, 2012

Presenter: Dustin Wilkes DO

Dermatology Program: St. Joseph Mercy Hospital

CHIEF COMPLAINT: asymptomatic hair loss x 1 week

CLINICAL HISTORY: A 3-year-old Caucasian female presented with her mother for the one-week history of asymptomatic hair loss of the scalp. No family history of alopecia was noted.

Waxing and waning eruption located on the trunk and extremities

August 5, 2012

Presenter: Christina Feser DO, Arathi Goldsmith DO, Peter Saitta DO, Jean Holland DO, Stephen Olsen DO

Dermatology Program: Oakwood Southshore Medical Center

CHIEF COMPLAINT: Resistant rash

CLINICAL HISTORY: September 2009-May 2010: A 61-year-old Caucasian female presented to our clinic with a 1-year history of a waxing and waning eruption located on the trunk and extremities. The patient denied pain and pruritus. No significant past medical history or family history was noted. The patient was otherwise healthy. A review of systems was unremarkable. May 2010-November 2010: The rash failed to resolve after multiple courses of topical and systemic steroids. Despite treatment, the eruption generalized. November 2010-August 2012: The patient’s condition continued to evolve becoming more diffuse throughout the trunk and extremities despite additional treatment trials with dapsone and acitretin. Finally, cyclosporine was added leading to the diagnostic eruption.

Tender scalp lesion

July 26, 2012

Presenter: Mounir Wassef, D.O.

Dermatology Program: Columbia Hospital, West Palm Beach (PBCGME)

CHIEF COMPLAINT: tender scalp lesion x 3 weeks.

CLINICAL HISTORY: 64-year old woman with history of hemochromatosis presented with a tender scalp lesion x 3 weeks. She complained of hair loss and tenderness. No prior treatments.

Multiple flesh colored papules on face and trunk

June 27, 2014

Presenter: Sarah Croft DO, Jill Salyards DO, Brandon Shutty DO

Dermatology Program: Nova Southeastern University/Largo Medical Center

CHIEF COMPLAINT: multiple pruritic “bumps” on his back

CLINICAL HISTORY: A 52-year-old Caucasian male presents for an initial evaluation with multiple pruritic “bumps” on his back that seem to be increasing in number over 2 years time as well as new lesions on the cheeks that he cuts while shaving. Topical emollients do not relieve symptoms.

Multiple asymptomatic “white” patches

June 27, 2014

Presenter: Alexandra Grob, DO, Kristi Hawley, DO

Dermatology Program: Oakwood Southshore Medical Center

CHIEF COMPLAINT: multiple asymptomatic “white” patches present since birth

CLINICAL HISTORY: A 14-year-old Caucasian female presented with multiple asymptomatic “white” patches on her forehead, bilateral arms, and legs, present since birth. She states the patches have grown in proportion to her growth, and that “brown spots” gradually began to form within and around these areas. She states her father and paternal grandfather also have similar clinical findings. A review of systems was negative for hearing impairment, ocular abnormalities, or recurrent infections. She denies any previous treatment.

Ulcerative lesions in returning travelers

May 27, 2014

Presenter: Shana Rissmiller, DO, Sarah Ferrer, DO, Emily Matthews, DO, Jamie Groh, DO

Dermatology Program: West Palm Hospital/ Palm Beach Consortium for Graduate Medical Education

CHIEF COMPLAINT: An evolving ulcerative lesion on the left forearm

CLINICAL HISTORY: A 51-year-old Colombian male presented to the office with an approximately 3-week history of an evolving ulcerative lesion on the left forearm. He first noticed the lesion shortly after returning from a 2-month recreational stay in Colombia. He denied any known trauma or arthropod assault. The lesion reportedly began as a non-pruritic erythematous papule. Over the course of the subsequent weeks, the area enlarged, ulcerated, and became crusted. He denied fever, chills, or abdominal pain.

Pruritic, painful callus on the toe

March 27, 2014

Presenter: Ashley Feneran, D.O., Sital Patel, D.O., Kevin Cooper, M.D.

Dermatology Program: University Hospitals Richmond Medical Center

CHIEF COMPLAINT: A new-onset callus on the left third toe

CLINICAL HISTORY: 40-year-old Caucasian female with no significant past medical history who presents with a new-onset callus on the left third toe. Initially, the patient complained of pruritus and pain at the site which worsened over time. Eventually, the site drained purulent exudate. Three 7-day courses of levofloxacin 500mg daily prior to presenting to dermatology. Prior to the development of the lesion, the patient admits to traveling to Kenya to perform in rural outreach projects. A bone scan was negative for osteomyelitis.

Rash with occasional small blisters

March 27, 2014

Presenter: Sean Branch, D.O., Ryan Owen, D.O., Luis Soro, D.O., Christian Oram, D.O., Stephen Hemperly, D.O., and Kelly Reed, D.O.

Dermatology Program: Lehigh Valley Health Network/Philadelphia College of Osteopathic Medicine

CHIEF COMPLAINT: rash with occasional small blisters

CLINICAL HISTORY: A 79-year-old male complained of a rash with occasional small blisters. The generalized rash began 4 months ago and was mildly pruritic. Small blisters appeared to rupture easily and leave behind superficial erosions. There was no history of any new or changing medications prior to the onset of his rash. Triamcinolone 0.1% cream helped somewhat. The rash improved with a course of oral corticosteroids but returned once the medication was completed. The patient could not tolerate methotrexate or azathioprine.

65-year-old gentleman with erythematous induration of the skin on his back

January 27, 2014

Presenter: Donna Tran, DO

Dermatology Program: Western University / College Medical Center

CHIEF COMPLAINT: hardening of back

CLINICAL HISTORY: A 65-year-old gentleman presented to our dermatology clinic with complaints of hardening of his back. Painless, progressive hardening of his upper back present for years. He denied any associated symptoms. Denied any previous treatment. Past medical history was significant for insulin-dependent diabetes mellitus.

Rapidly expanding necrotic plaques in an elderly woman

January 27, 2014

Presenter: Cathy Koger D.O., Steve Plumb D.O., Chris Cook D.O., Doug Richley D.O.

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: rapidly expanding necrotic plaques of her lower extremities

CLINICAL HISTORY: An 84-year-old Caucasian female presented with rapidly expanding necrotic plaques on her lower extremities that had developed over the past two months. The lesions, characterized by a reticulated pattern, were ulcerated, measuring approximately 15 cm, and extremely painful to the touch. They exhibited a firm, indurated texture and were accompanied by cord-like subcutaneous swellings. The patient had not received any previous treatment for these lesions. She resided in a local assisted living facility, where she received symptomatic care as needed. Her past medical history included hypercholesterolemia, for which she was prescribed Simvastatin, as well as a history of atrial fibrillation that required Warfarin. Notably, she had no prior history of skin cancer or other cutaneous issues.

A 53-year-old male with pruritic red papules

December 27, 2013

Presenter: Scott Thomas DO, John Young MD, Angela Bohlke MD

Dermatology Program: Silver Falls Dermatology/Western University of Health Sciences

CHIEF COMPLAINT: Itchy bumps on body

CLINICAL HISTORY: A 53-year-old male presented to the clinic with complaints of itchy bumps on his body, which had been present for approximately a year and a half. He reported no associated systemic symptoms, recent travel, known exposure to tuberculosis, or prior occurrences of similar symptoms. The patient denied having received any previous treatment for his condition. His social history was unremarkable, and his past medical history was significant only for idiopathic myelofibrosis, for which he had recently started chemotherapy one week prior.

Facial “acne” that has been present for entire life

December 27, 2013

Presenter: Chris Hixon, DO

Dermatology Program: Lewis Gale Hospital Montgomery

CHIEF COMPLAINT: Facial “acne” that has been present her entire life

CLINICAL HISTORY:A 23-year-old female presented to our dermatology clinic seeking treatment for worsening facial “acne,” a condition she has experienced for her entire life. During her initial visit, she was found to have diffuse closed comedones and flesh-colored papules on her forehead and lateral cheeks, along with areas of “ice pick” and atrophic scarring, as well as focal post-inflammatory hyperpigmentation (PIH). Her previous treatments included over-the-counter Clean & Clear Blackhead Eraser, Tazorac 0.05% cream applied nightly, Minocycline 100 mg daily, Doxycycline 150 mg daily, and Tretinoin 0.025% cream applied nightly. Notably, her dermatological history revealed a family history of acne, with both her and her father affected. She reported no chronic medical conditions, but her family history included instances of seizures.

Sudden purpuric rash on the lower legs

November 27, 2013

Presenter: Nathan Jackson DO, Brittany Carter DO

Dermatology Program: Tri-County Dermatology

CHIEF COMPLAINT: New onset rash on the legs and feet x 4 days

CLINICAL HISTORY: A 45 year-old Caucasian Female presented with complaint of new onset rash on the legs and feet of 4 days duration. Patient notes initially lesions started as red bumps on the bilateral lower extremities and then developed into “blisters” that had prominent pruritus and burning component. These lesions were painful and accompanied by noticeable swelling. She does feel she had “hives” one week prior to the rash. This was her initial assessment. Medical history included an essential tremor for which she has taken Propranolol for several years. Surgical history included a cholecystectomy, Caesarean section x 2, hysterectomy and tubal ligation (was non-contributory). She has an allergy to latex for which she has not had recent exposure. Most recent events were a “spider bite” two to three weeks prior at which she did not seek treatment. She has no recent infections, exposures to new drugs or chemicals, or other ROS such as arthritis, arthralgias, or systemic involvement except as listed above.

Hyperkeratotic rash in an adult female

November 27, 2013

Presenter: James Yousif DO, Brandon Yousif

Dermatology Program: MSUCOM/Lakeland Regional Medical Center

CHIEF COMPLAINT: Thickening of the skin on both bottoms of the feet and between the toes

CLINICAL HISTORY: A 50-year-old Caucasian female presented with a ten-year history of thickening of the skin on both bottoms of the feet and between the toes. This eruption was persistent in nature and was associated with significant pain with ambulation and pruritus. A review of systems was also positive for persistent numbness at the base of the digits of her feet. Prior treatment included the use of topical corticosteroid cream for the cutaneous eruption and gabapentin for the associated neuropathy, but both proved ineffective in providing symptomatic relief. Past medical history was positive for type II diabetes mellitus and dyslipidemia. No remarkable dermatologic history was noted, and family history was positive for a paternal grandfather with malignant melanoma.

Well circumscribed pedunculated friable nodule on the scalp

October 27, 2013

Presenter: Leeor Porges DO, Khasha Touloei DO, Alexis Stephens DO, Lise Brown DO, Jacqueline Thomas DO, Tracy Favreau DO

Dermatology Program: Broward General Medical Center

CHIEF COMPLAINT: Well circumscribed pedunculated friable nodule on her scalp

CLINICAL HISTORY: A 25 year old female presented with a 2 month history of a 2.4cm well circumscribed pedunculated friable nodule on her scalp. The patient had no previous medical history. The patient denied pruritus or pain from the lesion. Clinically the lesion resembled a pyogenic granuloma. A biopsy was performed which revealed alternating nests of adipose and myxoid elements with multiple dilated vascular structures.

Skin tag.. or is it?

October 27, 2013

Presenter: Tang Le DO, Angie Koriakos DO, Robert Lin DO

Dermatology Program: South Texas Osteopathic Dermatology

CHIEF COMPLAINT: Skin tags at both his axillae and around his neck

CLINICAL HISTORY: A 68-year-old Hispanic male presented to the clinic for removal of skin tags at both his axillae and around his neck. They had been present for a long period of time and they had interfered with his shirt collar and his necklace. He has a history of controlled type II diabetic mellitus, hypertension. He has no personal or family history of skin cancer. He had a cholecystectomy at the age of 25. He lived on a farm and had been frequently exposed to sunlight on a daily basis. He admitted occasional alcohol consumption but denied any tobacco used. He was Fitzpatrick skin type IV with moderate to severe sun damage. He was overweight.

Multiple nodules arising in a tattoo

September 26, 2013

Presenter: Eugene Sanik DO, Jordan Fabrikant DO

Dermatology Program: Larkin Community Hospital / NSUCOM

CHIEF COMPLAINT: Multiple asymptomatic nodular lesions confined to the red areas of a new multicolored tattoo located on the left forearm

CLINICAL HISTORY: A healthy 57-year-old Caucasian male presents with multiple asymptomatic nodular lesions confined to the red areas of a new multicolored tattoo located on the left forearm. The tattoo was made two weeks earlier by the same professional artist who had done several tattoos for our patient in the past. Past medical history was negative for skin cancers and immunosuppression. Social history was significant for the patient who has been a World Trade Center rescuer with the New York Fire Department.

Woman with unusual nodules on her trunk and extremities

August 26, 2013

Presenter: Theresa Zaleski DO, Kelli Mayo Danowski DO, Kate Messana DO

Dermatology Program: St. Joseph Mercy Dermatology Program

CHIEF COMPLAINT: Nodules x 20 years

CLINICAL HISTORY: A 58-year-old Caucasian female presented with numerous slightly tender nodules on the trunk and upper and lower extremities for 20 years. No previous treatments. The patient’s past medical history was significant for previous leiomyomata of the uterus, resulting in a hysterectomy in the early 1990s. Otherwise, the review of systems was negative. Family history was positive for a renal mass of unknown type in the patient’s sister.

Multiple lesions on face and hands for years

July 26, 2013

Presenter: Jamie Hale DO, Rick Limbert DO, Stacey Seastrom DO

Dermatology Program: Largo Medical Center/NSUCOM

CHIEF COMPLAINT: “Bumps” on his face and multiple lesions on his hands and feet for “years”

CLINICAL HISTORY: 11 y/o AA male presented for evaluation of a “bumps” on his face and multiple lesions on his hands and feet for “years”. This patient presented with a several year history of multiple lesions on his face and hands. They were asymptomatic, not present at birth, and more prominent after bathing on his feet. He denied headaches or vision changes. His past medical history was significant for odontogenic keratocysts of his right maxilla, left maxilla and mandible at the age of 10 with subsequent excision of these keratocysts. He was not on any medications at this time. The patient’s family history was negative for any skin disorders. An MRI of his brain revealed calcifications along the tentorium in the midline. A dental panoramic radiograph revealed prior keratocysts. Skeletal radiographs, ophthalmology evaluation, and genetic counseling were also ordered and he was found to be positive for the PTCH1 gene mutation. At this time he was diagnosed with Nevoid Basal Cell Carcinoma Syndrome. Previously, excision of maxillary and mandibular keratocysts was performed. Multiple excisions of facial basal cell carcinomas under general anesthesia with plastic surgery and ED&C’s of his basal cell carcinomas were performed with subsequent keloid formation. The patient is currently using topical imiquimod 5% cream 5 times weekly and tretinoin 0.1% cream to his face.

Rapidly progressive erythema

May 27, 2015

Presenter: Portela D., Laffer M

Dermatology Program: Oakwood Hospital – Southshore

CHIEFCOMPLAINT: Erythematous papules and patches progressing from head to chest and upper arms after sunburn

CLINICAL HISTORY: A 50-year-old Caucasian male presented with a three-day history of mildly pruritic erythematous papules and patches progressing from his head to his chest and upper arms after experiencing a sunburn during work. The patient complained of a pruritic erythematous rash from his scalp to the mid trunk. Additionally, there was erythema and hyperkeratosis of his hands and feet. The patient’s primary care provider had been treating the patch with a mid potency topical corticosteroid. The patient had a family history significant for psoriasis. He has a past medical history significant for hypertension, treated with atenolol. A review of systems was negative for constitutional symptoms.

Scalp nodule in a transplant patient

May 27, 2015

Presenter: Natalie Edgar DO, Dawnielle Endly DO, Joseph Dyer DO

Dermatology Program: Largo Medical Center / NSUCOM

CHIEF COMPLAINT: Scalp nodule enlarging over 5 weeks

CLINICAL HISTORY: A 49-year-old Caucasian male presented with a scalp nodule enlarging over 5 weeks. The nodule was intermittently bleeding but non-tender to palpation. No previous treatment. Past medical history was pertinent for cystic fibrosis necessitating bilateral lung transplants in 2009. Current medications included mycophenolate mofetil 1.5 g twice daily, tacrolimus 1 mg twice daily, and prednisolone 5 mg daily. He had no history of visceral malignancy.

Recurring hyperpigmented patches

April 27, 2015

Presenter: Christina Steinmetz-Rodriguez, DO

Dermatology Program: West Palm Hospital/PBCGME

CHIEF COMPLAINT: A 32-year-old Hispanic male presented to the dermatology clinic with recurring hyperpigmented patches on his face over the past year that was transient.

CLINICAL HISTORY: A 32-year-old Hispanic male presented to the dermatology clinic with recurring hyperpigmented patches on his face over the past year that was transient. Lesions would erupt in the same location on his face each time on a monthly basis and resolve in 6 to 7 days. Denied any prior medical history and reported no medication use including over-the-counter medications.

Lower extremity lesions in a female with Graves’ disease

April 27, 2015

Presenter: Cherise Khani, DO

Dermatology Program: St. Barnabas Hospital

CHIEF COMPLAINT: Swelling of bilateral lower extremities x 2 years and “raised circles on right shin and toes” x 9 months

CLINICAL HISTORY: A 44 year-old female presented with swelling of her bilateral lower extremities x 2 years, and “raised circles on right shin and toes” x 9 months. Lesions of the right lower extremity were associated only with mild intermittent pruritus. The patient denied pain, numbness, or paresthesias of affected area. She was diagnosed with Graves’ disease in 2009 and successfully treated with radioactive iodine. Resultant hypothyroidism has been well controlled with levothyroxine, without recurrence of symptoms. The patient had a recent surgical excision of masses on right and left great toes, as well as degenerated sesamoid bone of the right foot. The surgical pathology demonstrated benign fibroconnective tissue, showing a myxoid-mucoid background.

Painful, recurrent, bleeding ulcers

April 27, 2015

Dermatology Program: Botsford/McLaren/MSU

CHIEF COMPLAINT: Many-year history of painful, recurrent, bleeding ulcers on her bilateral feet

CLINICAL HISTORY: An 18-year-old female with a history of acne and eczema presented with a many-year history of painful, recurrent, bleeding ulcers on her bilateral feet. She stated that she gets blister-like lesions on especially when on her feet a lot during sports seasons. She had never received treatment for the lesions. Review of systems was negative for any malaise, recent illness, shortness of breath, fatigue, weight loss, or weight gain, and positive for hyperhidrosis of the feet. She was otherwise healthy.

Nodule on the vertex of the scalp

February 27, 2015

Presenter: Stephen Hemperly, DO

Dermatology Program: Lehigh Valley Health Network

CHIEF COMPLAINT: 1-year history of a nodule on the vertex of the scalp

CLINICAL HISTORY: Our patient is a 71-year-old Caucasian male who presented with a one-year history of a nodule on the vertex of the scalp. The lesion had become soft and tender during the week prior to the presentation. He admitted to headaches and a buzzing sound in his head. He denied all other neurologic symptoms. The patient was given amoxicillin from a primary care physician and was referred to us for excision of a presumed inflamed cyst.

54 year old man with multiple sores

May 27, 2016

Presenter: Mike Garone DO, Natalie Steinhoff DO, Jessie Perkins DO

Dermatology Program: NSUCOM/Largo Medical Center

CHIEF COMPLAINT: Multiple “sores” on the left hand, chest, and right neck

CLINICAL HISTORY: A 54-year-old man presents with multiple “sores” on his left hand, chest, and right neck. His clinical history reveals no signs of fevers, chills, night sweats, or unexplained weight loss. He denies experiencing nasal congestion, sore throat, epistaxis, mucosal erosions, nausea, vomiting, diarrhea, hematochezia, or melena. There is no reported history of immunodeficiency or HIV. However, he does report chest congestion and rhinorrhea occurring every morning, although he denies any prior history of allergic rhinitis. The patient’s past medical history includes hypothyroidism, and he has a negative surgical history. His family history is notable for a father with prostate cancer. Socially, he works as a government-contracted pilot, making frequent trips to the Middle East. He consumes alcohol socially but denies tobacco use or illicit drug use. His current medication includes Levothyroxine, and he has no known drug allergies. Three months prior to this presentation, the patient was in Iraq, where he experienced insect bites. He reports that some of these bug bites never healed. Initially, he was treated by his primary care physician with permethrin and triamcinolone 0.1% topical cream. Subsequently, he was treated with systemic azithromycin and pimecrolimus topical.

Painful rash in 15 year-old female

May 27, 2016

Presenter: Leslie Mills, DO

Dermatology Program: West Palm Hospital/PBCGME

CHIEF COMPLAINT: Painful rash involving her face, neck, and ears

CLINICAL HISTORY: A 15-year-old female presented to the Emergency Department with a painful rash affecting her face, neck, and ears. Four days prior to admission, after returning from Georgia, she experienced tenderness and pressure in her facial area, which progressed to significant edema, particularly in the periorbital region. The rash initially appeared as intensely pruritic, erythematous papules and vesicles that rapidly ulcerated, producing clear-yellow drainage. The patient reported associated ocular pain but denied experiencing oral lesions, fever, or chills. She also had no recent trauma, sick contacts, or exposure to animals, nor had she engaged in outdoor activities or used new products.

Pruritic rash with proximal muscle weakness

April 27, 2016

Presenter: Duggan C., Jajou P.

Dermatology Program: Beaumont Hospital Trenton

CHIEF COMPLAINT: Pruritic spreading rash

CLINICAL HISTORY: The patient is a 64-year-old female with hypertension, hyperlipidemia, hypercholesterolemia, hypothyroid, and depression who presented to the clinic with a pruritic rash that started on her left wrist and then spread to her right arm, chest, scalp, and posterior neck. She denied any recent sun exposure. The patient admits to some difficulty arising from a seated position as well as fatigue while combing her hair. The patient had been given multiple topical steroids with only minimal relief of the rash and the associated pruritus. Lab work, muscle, and skin biopsy were ordered, as well as follow up with rheumatology in regards to a muscle biopsy. The patient had been to multiple physicians prior to coming to our clinic including an internal medicine physician, dermatologist, allergist, rheumatologist, as well as her primary care physician. The patient admits having all normal screening exams such as a mammogram/colonoscopy/pelvic examination as well as a recent CT of her chest, abdomen, and pelvis which didn’t reveal any abnormalities.

Burning and stinging red nodules on the dorsum of hands

April 27, 2016

Presenter: Jessica Vincent, DO

Dermatology Program: OhioHealth O’bleness Hospital

CHIEF COMPLAINT: Burning and stinging red nodules on the dorsum of his hands x 1 year

CLINICAL HISTORY: A 57-year-old male presented to the current authors complaining of burning and stinging red nodules on the dorsum of his hands for about 1 year. He also admitted to the persistence of an episodic rash over the lower legs and bilateral flanks he had originally presented with 7 years prior. He was briefly treated with an oral prednisone taper and topical corticosteroids including triamcinolone 0.1% cream and clobetasol 0.05% cream without improvement. A biopsy 7 years prior revealed leukocytoclastic vasculitis (LCV) with prominent eosinophils. At the time, it was felt his skin findings were a manifestation of drug hypersensitivity, likely to opioid use. The patient was subsequently lost to follow up.

A 40 year old female with left sided facial swelling and lip swelling

February 27, 2016

Presenter: Huyenlan Nguyen, DO, Elise Grgurich, DO

Dermatology Program: Lehigh Valley Health Network/PCOM

CHIEF COMPLAINT: Left-sided facial swelling and lip swelling

CLINICAL HISTORY: A 40-year-old female with left-sided facial swelling and lip swelling. The most recent episode occurred one month ago and was associated with swelling of the face and lips. She feels the self-limited flares are related to stress and denies any associated new medications or provoking foods. She occasionally has numbness on the left side of her face that she attributes to her history of Bell’s palsy. She was treated with a course of prednisone and responded well.

Seven year old male with full body eruption

December 27, 2015

Presenter: Trent Gay, DO

Dermatology Program: Lewis Gale Hospital Montgomery

CHIEF COMPLAINT: Full body eruption

CLINICAL HISTORY: A 70-year-old male presented with a 4-month history of an asymptomatic, scaly, persistent full-body rash. He reported no preceding infections or recent travel and is otherwise in good health. His past medical history was unremarkable, with no current medications, significant family history, or surgical history. The patient lives at home with his parents, denies alcohol or tobacco use, and attends elementary school. He has no known drug allergies. At the time of presentation, two punch biopsies were performed, and the patient was prescribed desonide ointment and Sarna lotion. The biopsy results revealed non-specific spongiotic dermatitis. One month later, the patient returned for a follow-up and was placed on an oral steroid taper. Although the rash resolved during the steroid treatment, it reappeared upon tapering and remained unresponsive to the previous topical medications. Consequently, two additional punch biopsies were performed. Following the results, the patient was started on oral erythromycin.

Long standing upper body rash

November 27, 2015

Presenter: Stephen Colden Cahill, DO, Stephanie Juliet Kang, DO

Dermatology Program: Tri-county Dermatology, Ohio

CHIEF COMPLAINT: Rash on the body

CLINICAL HISTORY: In August, a 37-year-old Caucasian female (Fitzpatrick skin type 2) with a past medical history of depression, DJD, and spinal stenosis, presented for consultation regarding a five year pruritic rash over her face, neck, chest, shoulders, and arms. She was seen one month ago by her primary care physician, who performed lab work which showed an elevated CRP 31.3 (normal 0-5mG/L), normal CBC w/diff and negative ANA. She was placed on a 7 day prednisone taper and OTC loratidine. Her symptoms had mild short term relief and then promptly returned. She reports suffering from similar lesions over the last five years which have waxed and waned in intensity. She denies any new recent medications or herbal supplement additions. She cannot specifically associate the lesions with sun exposure. She denies any systemic symptoms, other than low back pain which has been an ongoing issue for several years. She is an active one pack per day smoker and occasional social drinker, denies any illicit or recreational drug use.

Infection of the lower leg not responding to antimicrobial therapy

October 27, 2015

Presenter: Shannon McKeen, DO

Dermatology Program: MSUCOM/Lakeland Regional Medical Center

CHIEF COMPLAINT: Infection on the left ankle

CLINICAL HISTORY: A 9-year-old female presented for evaluation of an infection on the left ankle. The patient injured her leg on a rock in Mobile Bay several months ago while on vacation with her family in Alabama. The wound was cultured and the patient was empirically started on Cephalexin by her primary care physician with little improvement. Wound culture from the outside office showed rare Staphylococcus epidermidis susceptible to Trimethoprim-Sulfamethoxazole. The patient is up to date on her Tetanus and other immunizations. No recent travel out of the country. The patient was started on Trimethoprim-Sulfamethoxazole and referred to Dermatology.

Generalized rash in 33 year-old female

October 27, 2015

Presenter: Liza Brown, DO, Francisco Kerdel, MD

Dermatology Program: Larkin Community Hospital (LCH/NSU-COM)

CHIEF COMPLAINT: Generalized “rash”

CLINICAL HISTORY: The patient is a 33-year-old female with a past medical history significant for asthma and bipolar disorder, who presented to Larkin Hospital dermatology service as a direct transfer for a “generalized rash”. Upon questioning, the patient stated she was started on Lamictal July 13, 2015, for her bipolar disorder. Two weeks after starting Lamictal patient reported developing angioedema and went to an ER near her home. She was given epinephrine and IV steroids with mild relief and was discharged home at that time. August 2, 2015 patient went back to the ER after the development of new symptoms; a generalized targetoid rash that began cephalad and extended caudally. The patient was admitted for three days and then was transferred to Larkin Community Hospital on August 5, 2015, after she began having sloughing of skin and dysphagia. Complete review of systems was within normal limits other than mentioned previously. The patient denied previous drug allergies, other new medications, or recent travel.

Atrophic dermatosis on bilateral legs

August 27, 2015

Presenter: Jennifer Peterson DO, Angelo Petropolis MD, Amy Weierman PA-C

Dermatology Program: Advanced Desert Dermatology

CHIEF COMPLAINT: Odd blotchiness on legs

CLINICAL HISTORY: A 65-year-old Caucasian female presented for evaluation of odd blotchiness on her legs. The patient reported onset of blotchiness on her legs approximately 1 month prior to presentation. She denied any local or constitutional symptoms associated with skin lesions. No history of recent travel or medication changes. Her past medical history is significant for hypothyroidism (controlled on levothyroxine), chronic arthritis, morbid obesity status-post gastric bypass surgery (with subsequent profound weight loss), and anemia secondary to malabsorption. A 10-point review of systems was performed, and did not reveal any new, evolving, or unexplained signs or symptoms.

Painful lower extremity nodules, pancreatitis, and polyarthritis

August 27, 2015

Presenter: Paul M. Graham

Dermatology Program: St. Joseph Mercy Dermatology

CHIEF COMPLAINT: Exquisitely painful nodules and marked edema of his bilateral lower legs

CLINICAL HISTORY: A 69-year-old Caucasian man presented with exquisitely painful nodules and marked edema of his bilateral lower legs. The nodules first appeared nine months ago and have shown a waxing and waning course. His past medical history includes chronic pancreatitis of unknown origin, hypertension, gastroesophageal reflux disease, inflammatory arthritis, and hypercholesterolemia. The patient reported experiencing painful skin nodules on his lower extremities for the past eight months, alongside joint pain and swelling in the metacarpophalangeal (MCP), metatarsophalangeal (MTP), and ankle joints. He had previously been treated with intralesional corticosteroid injections, which yielded only a marginal response. Additionally, he used high-potency topical corticosteroids and nonsteroidal anti-inflammatory drugs for symptomatic pain relief. Notably, the patient has a history of numerous hospital admissions for pancreatitis and is currently being managed by Rheumatology for his arthritic symptoms.

Purpuric rash in a 40-year old female abusing cocaine

August 27, 2015

Presenter: Carmen A Julian DO, Irina Milman DO, Eugene Sanik DO

Dermatology Program: PCOM/North Fulton Hospital Medical Campus

CHIEF COMPLAINT: Asymptomatic rash with purplish discoloration on her trunk, extremities and ears

CLINICAL HISTORY: A 40 year old female presenting with fever, cough, hemoptysis and an asymptomatic rash with purplish discoloration on her trunk, extremities and ears. The patient reported the rash started 5 days prior while she was undergoing inpatient treatment for pneumonia at a nearby hospital. The rash started on day two of her admission. She denies pain, bleeding or pruritus associated with the involved areas. She also denied any constitutional symptoms. She received empiric intravenous antibiotics for community-acquired pneumonia on her previous admission. She states that a punch biopsy was performed at her recent outside admission, but our attempts to obtain a report were unsuccessful. No specific treatment for her rash had yet been implemented. The patient left AMA from the previous hospital and presented to our hospital with worsening symptoms. Prior medical records, including the biopsy and antibiotic treatment, again were unavailable. She does admit to tobacco abuse and cocaine abuse, most recently 11 days prior during Independence Day weekend. She denies intravenous drug use.

Unusual vascular rash to trunk and extremities

August 27, 2015

Presenter: Laura F. Sandoval, DO, Jonathan S. Crane, DO

Dermatology Program: Sampson Regional Medical Center

CHIEF COMPLAINT: Rash on his trunk and upper and lower extremities

CLINICAL HISTORY: A 65-year-old male was referred by a vascular surgeon for a rash on his trunk and upper and lower extremities. The patient was being worked up for possible treatment of venous insufficiency of the lower extremities and the rash was of concern prior to any venous ablation procedures. The rash was present for 40 years and was asymptomatic.

Patient with multiple painful subcutaneous nodules

June 26, 2017

Presenter: Rachel Cetta DO, Sonam Rama DO

Dermatology Program: SCS/MSUCOM/Beaumont Hospital-Trenton

CHIEF COMPLAINT: Painful nodules located on her back and arms

CLINICAL HISTORY: A 55-year-old female with bipolar disorder, osteoarthritis, pulmonary embolism, deep vein thrombosis, breast cancer, and depression was referred to our office complaining of painful nodules located on her back and arms. The patient reported the lesions on her upper extremities and trunk had been present for forty plus years and had endured twenty-four excisions to remove these nodules. Patient stated the nodules were tender to palpation and would get severe sharp shooting pain in these lesions. Patient had tried gabapentin but it caused her to have dizziness, and patient was currently being treated with pregabalin (50 mg BID) for alleviation of pain. This did control the pain at times, but did not take it away completely.

Recurrent erythematous papules and nodules on the back of right lower leg

May 26, 2017

Presenter: Richard Winkelmann, DO; Jessica Hoy, DO; Kylee Sacksteder, DO; Gabriella Maloney, DO; Alyson Ridpath, DO

Dermatology Program: OhioHealth Dermatology Columbus, OH

CHIEF COMPLAINT: Recurrent bumps on back of right lower leg

CLINICAL HISTORY: A 64-year-old immunocompetent female presented with a seven-month history of recurrent erythematous papules and nodules on the back of her right lower leg. She reported that the nodules were tender, nonpruritic, and, at times, had a clear exudate. The patient denied any trauma to the area and initially attributed the eruption to mosquito bites. No previous treatments. Patient denied any personal or family history of skin cancers, and her medical history was unremarkable without prior exposure to tuberculosis or recent travel out of the country.

Multiple painful inflamed nodules, abscesses and draining sinus tracts

May 25, 2017

Presenter: Michael Lipp, D.O. Nady Hin, D.O., Rachel White, D.O.

Dermatology Program: LECOMT/Larkin Community Hospital Palm Springs Campus

CHIEF COMPLAINT: Inflammatory nodules/abscesses and joint pain

CLINICAL HISTORY: Twenty-year-old male presents with history of multiple painful inflamed nodules, abscesses and draining sinus tracts involving the face, chest, axilla, groin, and back for which was diagnosed as Hidradenitis Suppurativa (HS). Patient reports surgical history of multiple sinus tract excisions. Past medical history includes scarring acne of the face, chest, and back, pilonidal cyst that was surgically removed, and Crohn’s disease. Upon further questioning, it was learned that the patient was worked up at the hospital for back pain years prior. During that hospital stay an MRI revealed sacroiliitis and patient has been subsequently following up with a Rheumatologist.

One year history of an erythematous, mildly pruritic rash on the chest and breasts

March 25, 2017

Presenter: Roxanne Rajaii DO, Derek Hirschman DO, Summer Moon DO, Megan Furniss DO, Nichelle Arnold DO, Bryan Gray DO

Dermatology Program: Botsford Hospital

CHIEF COMPLAINT: Erythematous and mildly pruritic rash on central chest and bilateral breasts.

CLINICAL HISTORY: A 29-year-old Caucasian female presented with chief complaint of an erythematous and mildly pruritic rash localized to bilateral breasts and present for approximately one year. The patient denied any recent infections, new medications, or exacerbating factors. She denied any other constitutional symptoms including but not limited to fever, chills, and night sweats. She did admit to a long-standing history of smoking but stated that she is in the process of cessation. Patient reported exacerbation of skin lesions with sun exposure. Patient had been previously treated with topical combination hydrocortisone and lotramine, as well as topical clotrimazole/betamethasone diproprionate ointments with no improvement.

A diffuse and morphologically diverse rash in a traveler

January 17, 2017

Presenter: Leslie Marshall, D.O.

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: “itchy rash”

CLINICAL HISTORY: A previously healthy, non-pregnant 22-year-old Hispanic female presented with a 5-day history of a pruritic eruption on her dorsal right hand, upper arms, and back. She had returned to the United States 4 days prior after a 2-week trip to Santa Anna, El Salvador. Her symptoms began one week after her arrival to El Salvador with neck swelling and general malaise. One day before returning home (day 7 of illness), she developed tenderness and swelling surrounding a mosquito bite on her right ankle followed by a rash on her arms, back, and thighs. Accompanying symptoms included arthralgias in her hands, a low-grade fever, headache, and paresthesias. She was prescribed a prednisone taper from the ER physician, which was not helpful. She reported being bitten several times by mosquitos while in El Salvador.

Diffuse hypopigmented rash on an eight year old girl

January 1, 2017

Presenter: Sheena Nguyen, DO

Dermatology Program: Western University of Health Sciences/Chino Valley Medical Center

CHIEF COMPLAINT: White spots all over body

CLINICAL HISTORY: The patient is an eight-year-old girl who presented to the clinic with a three-year history of asymptomatic, hypopigmented macules diffusely spread throughout her body. She denied any preceding illnesses or systemic symptoms. The patient’s mother reported that they had been prescribed and used Triamcinolone 0.1% ointment on the affected areas twice daily for one month, but there was no improvement in her condition. In terms of her medical history, the patient has none of significance. She is currently not taking any medications, and her family history is non-contributory. Socially, she lives at home with her parents, attends elementary school, and denies the use of alcohol, tobacco, or illicit drugs. There has been no recent travel, and she has no surgical history. Additionally, the patient has no known drug allergies (NKDA).

Lifelong history of brown macules on the lips, buccal mucosa, and hands

December 27, 2016

Presenter: Robert Murgia, DO

Dermatology Program: LewisGale Hospital Montgomery

CHIEF COMPLAINT: Brown macules on lips and hands

CLINICAL HISTORY: The patient is a 34-year-old male who presented for a benign skin complaint and upon questioning, reported a lifelong history of brown macules on the lips, buccal mucosa, and hands. At age 13, he presented to his local emergency department with abdominal pain. He was told that this was likely a viral illness, and the pain resolved spontaneously over the next few days. A similar self-resolving episode occurred two years later. At age 16, the pain again returned while the patient was camping, and he was found to have a small bowel obstruction and intussusception. Additionally, he was found to have three large hamartomatous polyps requiring a partial hemicolectomy. He has since had several endoscopies and colonoscopies, as well as numerous gastric and colonic polypectomies. No previous treatments to the lesions. Of note, two brothers (32 and 23), both with similar findings. Father and paternal uncle with similar findings.

Purpuric rash in a patient with methamphetamine abuse

December 24, 2016

Presenter: Doug Richley DO, Emily Kollmann DO, Nicole Tillman DO , Gabriel Guerrero DO

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: New purpuric rash on the palmar hands, plantar feet, and perianal region

CLINICAL HISTORY: A 53-year-old female was referred to our office complaining of a new purpuric rash on the palmar hands, plantar feet, and perianal region. The patient reported the rash had been present for six days and she denied any pain or pruritus. She denied any systemic symptoms. No previous treatments. The patient admitted to methamphetamine use the night prior to the onset of the rash. Stating this was her first experience with methamphetamines however she has a known history of drug abuse. She was taking several oral medications daily however none were recently prescribed.

Generalized erythema and scaling

December 2, 2016

Presenter: Alyssa Miceli, DO, Jessica Newburger, DO

Dermatology Program: OMNEE/Park Avenue Dermatology

CHIEF COMPLAINT: Generalized rash

CLINICAL HISTORY: The patient is a 64-year-old Caucasian female with Turner syndrome, CHF, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, psoriasis and chronic kidney disease was seen as a consultation for a generalized rash that began two days prior to presentation. The patient complained of itching and mild pain of the skin. She was started on fluconazole for a yeast infection and ciprofloxacin for a urinary tract infection five and four days prior to presentation, respectively. The patient had also recently been admitted to the hospital for approximately one month, initially for a CHF exacerbation followed by placement of a gastrostomy tube. New medications during that admission included spironolactone and torsemide. The patient reported a long-standing history of psoriasis for which she has been treated intermittently since childhood. She denied recent exacerbations and was not currently using any topical medications. A review of systems was negative for any acute systemic symptoms.

Mysterious rash and neurological deficits

November 27, 2016

Presenter: Michelle Elway DO, George Brant DO, Jonathan Bielfield DO

Dermatology Program: Colorado Dermatology Institute, RVU

CHIEF COMPLAINT: Diffuse rash

CLINICAL HISTORY: A 44-year-old Burmese female with no significant past medical history presented with fever, pain, swelling, and erythema of her right thumb after a closed injury while working with raw chicken at work. She was diagnosed with a felon and a P1 fracture, subsequently undergoing an I&D. She was then placed on vancomycin, ceftriaxone, and metronidazole for possible exposure to raw chicken to cover empirically for enteric bacteria (salmonella, E. coli, Enterococcus) as well as for skin flora with negative cultures. While being evaluated by ID, they noted multiple dry, erythematous plaques on the face and extremities. They determined “it was likely rheumatologic”, as the patient reported it being present since 2014, and treated by her PCP in Burma. No further workup was performed on that admission. The patient’s thumb improved, and she was discharged home three days later with a 5-day course of Bactrim and amoxicillin.

58yo female with hyperpigmented papules on arms and palms

November 27, 2016

Presenter: Olga Demidova, DO; Laura Jordan, DO; Cole Cahill, DO; Schield Wikas, DO; Monte Fox, DO

Dermatology Program: Tri-County Dermatology

CHIEF COMPLAINT: Asymptomatic hyperpigmented papules over arms and palms

CLINICAL HISTORY: A 58-year-old female was referred to the dermatology clinic by her primary care physician for evaluation of asymptomatic hyperpigmented papules involving her arms and palms. Growths appeared several weeks prior to the initial visit. During the visit, the patient reported mild shortness of breath that is chronic for her and may have worsened in the past few weeks. She denied changes in medications and any recent illness. No previous treatments to the papules. Her past medical history consisted of asthma, COPD, GERD, atrial fibrillation, breast cancer, hypertension, hypothyroidism, infantile seizures, and radiation treatments. Past surgical history included breast lumpectomy, breast biopsy, cholecystectomy, and hysterectomy. The patient denied any personal or family history of skin disease or skin cancer. Her medications at the time included atenolol, levothyroxine, flomax, hydrochlorothiazide, ibuprofen, and probiotics, and she admitted allergies to adhesive tape, voltaren, dolobid, vicodin, calan, lipitor, crestor, zetia, and simvastatin. Patient was a former cigarette smoker and denied alcohol use.

Worsening rash in female with history of cord blood transplant

October 27, 2016

Presenter: John Howard, DO

Dermatology Program: Larkin Community Hospital/NSU-COM, South Miami, FL

CHIEF COMPLAINT: progressively worsening pruritic rash on her extremities and trunk

CLINICAL HISTORY: A 12-year-old African American female with a history of immunodeficiency syndrome due to an NF-kappa-B essential modulator (NEMO) gene mutation, currently status post umbilical CBT before age 1 with myeloablation-induced hypothyroidism and hypoestrogenism, presented to Advanced Dermatology & Cosmetic Surgery in Margate, Florida as an outpatient complaining of a progressively worsening, pruritic, hypertrophic, and lichenified plaques and papules on truck and extremities for several months. The patient denies preceding or current upper respiratory infection, cough, sore throat, fever, chills, arthralgias, or diarrhea. She presents with recent negative bloodwork for South Florida environment allergy panel and negative T.R.U.E. allergy patch testing. Her only medications are levothyroxine 62.5mcg daily and estradiol 0.025 mg/hr weekly patch for Hashimoto thyroiditis-induced hypothyroidism and hypoestrogenism respectively. She has no known drug allergies. Family history is significant for an older brother who unfortunately passed away shortly after birth due to a NEMO mutation and the mother states she is the carrier. Patient has been using mild-potency topical steroid creams and oils and lotions.

Incidentally, her mother was noted to have dark brown hyperpigmented thin plaques in a blaschkoid distribution on bilateral posterior lower extremities. The mother refused a skin biopsy, which was explained could support the clinical impression of IP. Taken in total, mother and daughter share a mutation in NEMO, however, the mother’s phenotype is that of IP and the daughter’s phenotype that of anhidrotic ectodermal dysplasia with immunodeficiency (AED-ID).

Persistent nipple dermatitis

October 27, 2016

Presenter: Shannon McKeen, DO

Dermatology Program: MSUCOM/Lakeland Regional Medical Center

CHIEF COMPLAINT: Persistent rash on the right breast

CLINICAL HISTORY: A 63-year-old Caucasian female with a persistent rash on the right breast. In February of 2000, the patient underwent excision of ductal carcinoma in situ, a high nuclear grade with focal micro-invasion of the right breast. This was followed by eight weeks of radiation therapy and a five-year course of tamoxifen. She did not seek to follow up imaging until 2004, which had shown calcifications. Biopsy of the calcifications showed recurrent ductal carcinoma in situ. At that time, the surgeon recommended mastectomy with axillary lymph node dissection. The patient refused due to concerns over loss of function and swelling in the arm. In 2016, several months prior to her presentation in our office, the patient developed a rash on the right breast. The rash involved the areola and periareolar skin. The patient described the rash as red, itchy, and mild in severity. She was seen by her Gynecologist who gave her a topical corticosteroid cream, which helped improve the rash somewhat, only to return upon discontinuation. The patient also reported using a “diaper rash cream” which mildly improved her symptoms. The Gynecologist ordered a 3D mammography and subsequent ultrasound. Both reports were read as having dystrophic calcifications, recommending six months follow up exams. The patient was referred to our office for her persistent rash. At the initial consultation, we ordered an MRI of the right breast, referred her to the general surgeon who performed the initial excision in 2000, and the patient was given samples of flurandrenolide 0.05% cream to apply twice daily until follow up. The patient called several days later and refused MRI, as well as canceled the appointment with the general surgeon. She was instructed to return to the office for a biopsy.

15 year old with hair loss since 3 months of age

August 27, 2016

Presenter: Kevin Svancara, DO, Jonathan Bellew, DO

Dermatology Program: Advanced Desert Dermatology (MWU)

CHIEF COMPLAINT: Hair loss and thinning of the scalp

CLINICAL HISTORY: A 15-year-old female presents with diffuse hair loss and thinning of the scalp, with the most significant loss occurring on the posterior aspect. She reports that her scalp is flaking, itching, and burning, with these symptoms having persisted since she was three months old. The patient also notes that her hair breaks very easily. Additionally, she describes small, rough bumps on the backs of her arms and lateral legs that occasionally itch. Her past medical history includes bipolar disorder, and she is currently taking Depakote and using ketoconazole 2% shampoo. There is no significant family history, including any known family history of similar hair conditions, and she does not have information regarding her father’s family history. Socially, she is a student, does not smoke, and does not consume alcohol. She has no surgical history and no known drug allergies (NKDA). Previously, the patient has been treated for seborrhea with ketoconazole shampoo for several years, washing her hair twice daily. While some improvement in scalp scaling has been noted, there has been no improvement in hair loss or thinning.

Pruritic, tender lesions on lower legs

July 27, 2016

Presenter: Vukmer DO , Tyler O. Petrosian

Dermatology Program: Hackensack at Palisades UMC

CHIEF COMPLAINT: Pruritic, tender lesions on his lower legs

CLINICAL HISTORY: A 68-year-old Hispanic male presented complaining of a 2-year history of very pruritic, tender lesions on his lower legs. The patient also complained of a years-long history of arthralgia and asthma. Infectious disease treated suspected cellulitis with rocephin and vancomycin. There was no improvement in skin lesions. Family history was positive for asthma, arthritis, diabetes, and thyroid disorders. The only medical allergy was to percocet. Medications at the time of presentation were: aspirin 81mg po qd, levothyroxine 25mcg PO QD, lovastatin 10mg PO QD, metoprolol 50mg PO QD, and montelukast 10mg PO QD.

Bilateral hand and feet nail changes unresponsive to antifungal

July 27, 2016

Presenter: Caitlin Porubsky, DO, Carmen Julian, DO, Irina Milman, DO

Dermatology Program: PCOM Mednet/North Fulton Hospital Medical Campus

CHIEF COMPLAINT: Changes in fingernails and toenails

CLINICAL HISTORY: A 65-year-old Caucasian female with a history of Ulcerative Colitis (UC) presented with nail changes on bilateral hands and feet. The patient started noticing nail changes about 18 months prior to presenting in the office. The patient previously saw a podiatrist, who performed nail clippings that showed onychomycosis. The patient was treated with a two-month course of oral itraconazole, yet her nail symptoms continued to worsen. Subsequently, 18 months prior the patient was started on infliximab for her UC. She continued on this therapy while nail changes progressed.

Painful, non-healing ulcer

July 27, 2016

Presenter: Jeffrey Kushner

Dermatology Program: Saint Joseph Mercy Health System

CHIEF COMPLAINT: Ulcer on her right breast x 3 weeks

CLINICAL HISTORY: A 63-year-old woman presented with a three-week history of an ulcer on her right breast. The ulcer was painful and non-healing. Application of topical mometasone cream provided no improvement. Past medical history included poorly differentiated invasive ductal carcinoma of the right breast status post lumpectomy, localized radiation therapy, and adjuvant chemotherapy with docetaxel and cyclophosphamide. Her final radiation treatment was one year prior to the onset of symptoms and was complicated by acute radiation dermatitis.

Non-radiating right upper quadrant abdominal pain

July 27, 2016

Presenter: Leeor Porges DO, Pamela Sheridan DO

Dermatology Program: Broward General Medical Center

CHIEF COMPLAINT: dark spots on torso and extremities

CLINICAL HISTORY: A 17-year-old girl admitted for evaluation of non-radiating right upper quadrant abdominal pain which had been present for 3 days. The further exam showed unique skin lesions and extracutaneous findings. Family history includes a mother with multiple cafe au lait macules.

Pruritic blistering eruption on the forearms of a 60 year old male

May 24, 2020

Presenter: Courtney N. Bernett, DO, Logan Kolb, DO, and Shawn Schmieder, DO

Dermatology Program: Orange Park Medical Center/Park Avenue Dermatology

CHIEF COMPLAINT: ¨Itchy sore blisters on forearms”

CLINICAL HISTORY: A 62-year old male was referred to the dermatology clinic by his primary care physician (PCP) for a blistering rash on his arms. Three months prior to his presentation, he started to develop severe pruritus on his bilateral forearms. Shortly after the pruritus started, he developed large, blood-tinged blisters on his forearms. These blisters would rupture, leak fluid, and dry up. The patient saw his PCP for his blisters and they suspected a drug reaction to Lisinopril which had recently been started prior to his rash. His lisinopril was discontinued and changed to metoprolol with no change in his blisters. No topical treatments were attempted at that time. The patient has a past medical history of diabetes mellitus type 2, hypertension, and gastroesophageal reflux disease. He denied a personal or family history of hepatitis B or C, autoimmune disease, irritable bowel disease, or a history of recent travel. He has no known allergies, and his medications include metformin 500mg QD, metoprolol succinate 50mg QD, and omeprazole 40mg QD.

Chronic axillary rash

May 28, 2018

Presenter: Jessica Kim DO

Dermatology Program: Palm Beach Consortium Graduate Medical Education

CHIEF COMPLAINT: Chronic bilateral axillary rash which developed over the course of a year

CLINICAL HISTORY: Patient presented with an asymptomatic rash localized to the axillae. Patient has tried changing deodorants and using talcum powder without improvement. Past medical history includes diabetes mellitus (HgA1c 6.2), hypothyroidism, stasis dermatitis, hand eczema and hypertension. Pt denies use of tobacco or illicit drugs. He is currently on levothyroxine, carvedilol, pregabalin, saxagliptin, tamsulosin, pantoprazole, glipizide, warfarin, lisinopril, metformin, and furosemide. His allergies include acetaminophen, morphine, hydromorphine, zocor, and niaspan.

Multiple papules and nodules in female patient

May 17, 2018

Presenter: Danielle Raffaella Lazzara, DO

Dermatology Program: Larkin Community Hospital Palm Springs

CHIEF COMPLAINT: 1 year history of multiple, brown lesions diffusely spread on body.

CLINICAL HISTORY: 66 year-old Hispanic female presented with a 1 year history of multiple, brown lesions located to the neck, chest, and upper back. The lesions were noted to be stable and asymptomatic with no aggravating factors. Patient denied fever, chills, arthralgia, weight loss, cough, shortness of breath, uveitis, back pain, abdominal/pelvic pain, hematuria, and dysuria. No previous treatment was performed. Patient’s medical history is significant for hypercholesterolemia managed medically with a statin and uterine fibroids for which she had a hysterectomy at age 33. She denies any pertinent family history.

A man with vegetative plaques and oral erosions

March 17, 2018

Presenter: Carl Barrick, DO and Tanya Ermolovich, DO

Dermatology Program: Lehigh Valley Health Network/PCOM

CHIEF COMPLAINT: vegetative plaques right axilla, umbilicus, bilateral inguinal folds and scrotum with extension to anus

CLINICAL HISTORY: 34 year-old Caucasian male with vegetative plaques right axilla, umbilicus, bilateral inguinal folds and scrotum with extension to anus. The patient presents with ulceration and crusting of his nose and lips for six weeks. He has had thick, crusted lesions and swelling of his scrotum for three months. The lesions are asymptomatic although the ulcerations in his mouth are painful. He admits to feeling well without fevers, chills, dysphagia, diarrhea, abdominal pain, or joint pain. No previous treatment to lesions.

Generalized blisters after nivolumab treatment

February 7, 2018

Presenter: Alyson Ridpath, DO

Dermatology Program: OhioHealth O’Bleness

CHIEF COMPLAINT: new-0nset severe, pruritic, bullous eruption

CLINICAL HISTORY: A 67-year-old male with stage IV BRAF- and c-Kit-negative, NRAS-positive melanoma of unknown primary with metastases to the liver, lung and brain was started on nivolumab 3 mg/kg every two weeks. After 16 cycles over 32 weeks, he presented to the emergency department with a new, severe, pruritic, bullous eruption covering approximately 90% body surface area, and altered mental status. He was started on 1 mg/kg prednisone daily and betamethasone diproprionate 0.05% cream twice daily with the intention of restarting nivolumab after the steroid taper. His course was complicated by bacteremia and an inability maintain his BP on low dose corticosteroids. The inability to taper the patient to low dose steroids to disinhibit cellular immunity was a therapeutic challenge.

Growing lesion on the cheek of a 12-year-old female

December 7, 2017

Presenter: Michelle Elway, DO

Dermatology Program: Colorado Dermatology Institute/Rocky Vista University

CHIEF COMPLAINT: new, growing lesion on her left cheek

CLINICAL HISTORY: A 12-year-old female was referred to our office by her Pediatrician complaining of a new, growing lesion on her left cheek. The patient and her mom reported that the lesion appeared approximately one month prior as a small reddish spot, which has since grown significantly. The patient denied changes in color, bleeding, ulceration, pain, pruritis, or crusting of the lesion. She also denied any systemic systems. They had no other concerns at that time. No previous treatments. The patient had no past medical history to note. Family history was non-pertinent.

A 32 year old male with a growth on his back

November 4, 2017

Presenter: Ryan T. Jones, DO

Dermatology Program: MSU/Lakeland Regional Medical Center

CHIEF COMPLAINT: A itchy, irritated growth on the back.

CLINICAL HISTORY: The patient is a 32-year-old male who presented to our clinic with a complaint of a growth on his back which had been present for one year only. The growth is irritated and itchy but is not tender or painful. Over the course of the year the lesion has very slowly enlarged with increased itch/irritation. The patient denied any changes in color or shape since he first noticed the lesion. He also denied any other concurrent skin findings or rashes since onset. No previous treatments. He denies any previous personal or family history of skin cancer, autoimmune, or rheumatologic disease. He denies having any known medical problems other than seasonal allergies, has not had any surgeries, has no significant family history, and denies any known allergies.

Pigmented papulonodular rash following axillary lymphadenectomy

September 30, 2017

Presenter: Jonathan Bellew, DO

Dermatology Program: Advanced Desert Dermatology

CHIEF COMPLAINT: Violaceous hyperpigmented rash on the right upper body

CLINICAL HISTORY: A 79-year-old Caucasian male presented to the outpatient office setting with a six-month history of progressive asymptomatic violaceous-black pigmented papules, plaques, and nodules of the right shoulder, axilla, chest, upper abdomen, and lateral trunk. The patient denied systemic complaints, pain, pruritis, or discomfort. Two months prior to the skin eruption the patient underwent primary resection of a right mid-back malignant melanoma. The melanoma was histologically classified as superficial spreading and nodular type with a Breslow’s thickness of 1.4 mm and Clark’s level IV, with no ulceration, lymphovascular invasion, or satellitosis. Sentinel node biopsy showed extension to the right axillary lymph nodes prompting axillary lymphadenectomy.

Eighty year old female with chronic lymphedema in left lower extremity

September 27, 2017

Presenter: Victoria Comeau, D.O., Alexandria Glass, D.O., Caitlin Porubsky, D.O., Carmen Julian, D.O., Marcus Goodman, D.O.

Dermatology Program: PCOM Dermatology Residency

CHIEF COMPLAINT: “spot” on the left leg

CLINICAL HISTORY: 80 year old female presented with a “blue” golf ball sized lesion which appeared on her left leg about 1.5 years ago and has gradually enlarged. No previous treatments. The patient has a past medical history of coronary artery disease, type 2 diabetes mellitus, depression, hypertension, and severe left leg lymphedema. Her lymphedema started in the 1960’s after a radical total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) secondary to cervical cancer. Her lymphedema had been stable, but progressed over the last few years.

Suspicious papules on nose, chest and back

September 27, 2017

Presenter: Angela Macri DO, Christopher Cook DO FAOCD, FAAD, Jonathan Crane DO FAOCD, FAAD

Dermatology Program: Sampson Regional Medical Center

CHIEF COMPLAINT: new lesions that appeared on her nose, chest, and back

CLINICAL HISTORY: A 41 year old Caucasian female presented to our dermatology clinic for new lesions that appeared on her nose, chest, and back over the past year. The lesions were not changing in size, were not painful or pruritic, and have not bled. No prior treatments. Her past medical history included colon cancer diagnosed at age 21, depression, GERD, squamous cell carcinoma of the vulva, and basal cell carcinoma diagnosed at age 25. Surgical history included total hysterectomy, colectomy, vulvectomy, and cholecystectomy. Her family history on her paternal side included colon cancer diagnosed in her father, grandfather, aunt, and two uncles. Her paternal aunt was diagnosed with breast cancer.

Chronic pruritic rash in a long-term care patient

July 27, 2017

Presenter: Brittany Grady, DO; Kevin Miller, DO; Charles Elias, DO; Shannon Wiedersum, DO; John Hassani, DO; Nicole Ruth, DO

Dermatology Program: Hackensack Meridian Health Palisades Medical Center

CHIEF COMPLAINT: long-standing pruritic rash involving his back, hands, and feet

CLINICAL HISTORY: A 92-year-old Caucasian, male, long-term care patient presents with a complaint of a long-standing pruritic rash involving his back, hands, and feet. The nursing staff reported the rash to be present for the past year while he had been a long-term resident in their care. The rash began on the hands and had slowly spread to involve his trunk and lower extremities. The patient reported mild, but tolerable, pruritus associated with the rash. The patient denied fevers, chills, headaches, abdominal pain, shortness of breath, or recent weight changes. The patient had been prescribed several mid- to high-potency topical corticosteroids as well as several topical antifungal creams over the past year by his primary care provider. Currently, the patient was using betamethasone/clotrimazole cream twice daily as well as urea cream daily with no improvement in his condition. The patient had been living in this long-term care facility for one year prior to our dermatology consultation. The patient denied recent travel or a history of household contacts with a similar rash prior to his admission to long-term care. The patient had a past medical history that included: dementia, cardiovascular disease, chronic kidney disease, hypertension, and osteoporosis.

Focal Atypical Lymphoid Infiltrate with CD30 Positivity in a 36-Year-Old Male

October 25, 2024

Presenter: Victoria Comeau, DO, Alexandria Glass, DO, David Lemchak, DO, Haley Lewis, DO, Caitlin Porubsky, DO

Dermatology Program: PCOM/North Fulton Hospital

CHIEF COMPLAINT: new growth under the right arm

CLINICAL HISTORY: A 36-year-old Caucasian male presented to the clinic with complaints of a new growth under the right arm that had been present for approximately 2 months and had progressively increased in size. He noted tenderness surrounding the lesion but aside from this, the lesion was asymptomatic. Review of systems was negative for any associated fevers, weight loss, night sweats, chest pain, shortness of breath, gastrointestinal discomfort, rash or edema. The patient had not received any previous treatment, as this was his initial presentation. He was, however, prescribed doxycycline due to concern for possible localized cellulitis. His past medical history was significant for hypertension, which was well controlled with Losartan. He denied any pertinent family history.

Itchy lesion on a marathon runner

October 28, 2018

Presenter: Adeline Kikam DO, Carlos A. Rivera MD

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨Itchy lesion on right leg”

CLINICAL HISTORY: 36-year-old Hispanic male complaining of a lesion on the right lateral leg that began sometime around September of 2017. The patient recalls itching but no pain to the area followed by mild scaling. He does not recall any foreign travel around September of 2017 but he says he runs bushy trails around Houston, Dallas, and Austin. His last international travel was to Cancun Mexico in 2016. He self-treated with Neosporin and Hibiclens but it did not resolve. He denies any systemic symptoms such as fever, fatigue, and weight loss. All other review system questions and physical exam was unremarkable.

Itchy Rash on Face and Body

October 24, 2018

Presenter: Christopher Mancuso, DO

Dermatology Program: Saint Barnabas Hospital

CHIEF COMPLAINT: Rash on face and trunk

CLINICAL HISTORY: A 59yo female with diabetes and hypertension presents with an itchy and painful rash that began on the face and scalp and spread to body over the course of 2 months. Her rash began after sitting in the sun at her summer home in Pennsylvania. She reports a 40lb weight loss and denies fever, chills, nausea, vomiting, or arthralgias. Denies any new medications or recent illness. Has never had similar issues in the past. Previous treatment with topical steroids was moderately effective.

Rare Inherited Skin Disorder Initially Misdiagnosed as Psoriasis

May 24, 2020

Presenter: Sarah Hocker, D.O. and Lauren Dozier, D.O.

Dermatology Program: Larkin Community Hospital, South Miami, FL

CHIEF COMPLAINT: A 12-year-old male with a history of blindness in his left eye, presented to our clinic for evaluation of an itchy, scaly rash on his body, face, and scalp.

CLINICAL HISTORY: The patient states that the rash had been present for 5 years now, and is worsening. He admits to itching but denies pain. The patient reports previously seeing a dermatologist a few years ago that performed two punch biopsies that came back as severe plaque psoriasis. He denies a family history of a similar rash. He tried lactic acid creams, urea cream, numerous topical and intralesional corticosteroids and pimecrolimus.

Patient with a 5 year long history of brown macule on left zygoma

May 20, 2020

Presenter: Soham Chaudhari, DO, Carlos Rivera, MD, Thomas L Davis, MD Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency program

CHIEF COMPLAINT: Brown solitary macule on the left cheek

CLINICAL HISTORY: A 38-year-old female with no past medical history who was referred to our dermatology clinic from her PCP for a lesion that has been present for 5 years. The patient denies any surgical history, medication use, allergies, or any type of family history of skin cancer. The patient also denies smoking, drinking alcohol, or use of illicit drugs.

Rare Lesion On a 9-Month-Old Infant

December 6, 2019

Presenter: Jeffrey Harbold, DO, Carlos A. Rivera MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency Program, HCA Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨My son has a rare lesion on his left arm”

CLINICAL HISTORY: A 9-month-old Hispanic male with an evolving asymptomatic linear atrophic plaque on the flexor surface of the left wrist extending to the left upper arm. The patient’s Mother reports the presence of lesion at birth. She also reports that the lesions have progressed in a linear pattern towards the proximal arm. The patient has a history of pyloric stenosis s/p pylorectomy, macrocephaly, and patent foramen ovale/peripheral pulmonic stenosis(PFO/PPS). No significant dermatological family history was reported, including history of skin cancer. At 5 months of age, the patient underwent a MRI Brian for the history of macrocephaly which demonstrated enlargement of the subarachnoid spaces. Echocardiogram was performed during infancy for the history of PFO/PPS that was otherwise normal.

Pink papules on both arms

October 8, 2019

Presenter: Jeffrey Harbold, DO, Carlos A. Rivera MD, Rick Lin, DO, Michael Hohnadel, DO, Thomas L Davis, MD

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨I have skin lesions on both arms”

CLINICAL HISTORY: A 45-year-old Hispanic male with a past medical history of Down syndrome was referred to our clinic with an 8-year history of numerous crops of hyperpigmented confluent smooth papules. Lesions originated on the flexural surfaces of both arms with subsequent spread to the lower torso and legs, with facial sparing. The patient reported occasional mild pruritus but denied any associated pain. Other dermatologic history include biopsy-confirmed scabies in 2015 successfully treated with topical permethrin and a history of rosacea controlled with metronidazole gel and an occasional oral minocycline. There was no significant dermatologic family history reported.

Rare skin and muscle lesions

August 9, 2019

Presenter: Christine Ku, DO; Michael Hohnadel DO; Rick Lin DO; Michael Sedrak MD.

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨I have a rash and other lesions on my fingers”

CLINICAL HISTORY: The patient is a 23-year-old female who presented to the clinic with a complaint of diffuse skin rash and ulcerations. She reported symptom onset about 12 months ago, with worsening of symptoms in the past 4-6 months. Symptoms began with cuticle inflammation consisting of redness and pain. She saw her primary care physician who prescribed topical therapy with some improvement. A few weeks later she noted wrist pain and swelling followed by the progressive development of diffuse arthralgia and arthritis in fingers, hands, and knees. The patient then described onset of a rash over thighs and buttocks which then spread to her torso and extremities. She described the rash as pruritic and slightly painful. This was followed by the development of skin ulcerations resulting in open, non-healing wounds on extremities as well as digital ulcers on hands and oral ulcers. Of note, the patient also reported an unintentional weight loss of 20 pounds over the past year (over 15% of her initial body weight). The patient denied fevers, change in vision, shortness of breath or chest pain, or other systemic symptoms. The patient was evaluated by rheumatology who trialed prednisone, methotrexate injections, and Plaquenil with some improvement in symptoms. The patient had no other significant medical or surgical history, was previously not taking any medications. It was noted that she had a positive family history of lupus in her maternal aunt and cousin.

Elderly gentleman with large violaceous plaques on left shin

October 24, 2024

Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: violaceous plaques on left leg

CLINICAL HISTORY: A 91-year-old gentleman with a history of hypertension, gastroesophageal reflux disease, and vitiligo presented to the clinic with two large violaceous ulcerated plaques on his left lower leg. The patient stated that a papule had formed four months prior after a ground-level fall, and it had continued to grow over the last few months, starting to bleed within a few weeks of his appointment. He denied experiencing pain, itchiness, fatigue, or other B symptoms, such as fever, weight loss, or night sweats. The patient also denied recent travel, smoking, using illicit drugs, drinking alcohol, or taking any new medications. His family history was notable for a deceased brother who had an unknown type of cancer. Current medications included carvedilol, doxazosin mesylate, isosorbide mononitrate, omeprazole, loratadine, clopidogrel bisulfate, losartan, benzonatate, and folic acid.

Large, Indurated, and Painful Plaque on the Forehead

September 30, 2024

Patient with chronic painful nodule on left third fingernail

September 30, 2024

Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: painful nodule on finger nail

CLINICAL HISTORY: A 79-year-old female with no significant past medical history presented to the clinic with a painful nodule on her left third fingernail that had been present for 10 years. The patient reported that the nodule had been slowly growing and became very painful when she submerged her hand in cold water. For the past two years, she had been treated by a midlevel provider who diagnosed her with onychomycosis and a bacterial infection of the left third fingernail. Despite multiple courses of doxycycline and ciclopirox, she noted no improvement in her condition.

Patient with multiple grouped vesicles surrounding border of a previous surgical scar

September 30, 2024

Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have persistent growths on my back around a prior surgical scar”

CLINICAL HISTORY: A 23-year-old male with no significant past medical history presented to our clinic with multiple grouped lesions on his back surrounding a previous scar. The patient and his parents reported that he has had these spots since childhood, though they could not confirm whether he was born with them. They also did not remember the specific surgical procedure that created the scar during his childhood. The patient was worried about the spots, as they had recently begun to bleed. He denied any personal or family history of skin cancer.

Post-Hospitalization Dilemma: Investigating Purple-Brown Plaques on the Chest

June 16, 2024

Presenter: Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have dark patches on both sides of my chest”

CLINICAL HISTORY: A 66-year-old Hispanic male presented to our clinic with a one-year history of mildly pruritic, purple to brown plaques located on both inframammary folds. The patient reported that the lesions first appeared one week after being hospitalized for a urinary tract infection complicated by sepsis. Initially, the lesions developed on the right inframammary fold and subsequently spread to the left side. He denies involvement of mucosal surfaces or nails. His medical history included diabetes, gout, hypertension, and dyslipidemia. He had a surgical history of a benign scrotal mass. He reported taking Novolog, Synjardy, allopurinol, lisinopril, metoprolol, and atorvastatin. The patient denied use of over-the-counter medications and reported no known drug allergies. He was a non-smoker, denied alcohol use, and was currently retired.

A Rapidly Growing, Tender Nodule on the Foot

June 12, 2024

Presenter: Eric Sandrock, DO, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have a painful bump growing on my foot”

CLINICAL HISTORY: A 40-year-old female with a medical history of anemia and hypothyroidism presented to our clinic with a two-month history of a rapidly growing, tender lesion on her right foot. The patient reported no prior trauma to the area and denied experiencing any similar lesions in the past. She also reported no discharge or itching at the site of the lesion. She reported no recent travel, exposure to sick contacts, and has no personal or family history of similar lesions or skin cancer.

A Pediatric Puzzle in the Perianal Area

March 25, 2024

Presenter: Eric Sandrock, DO, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: “multiple papules on buttocks”

CLINICAL HISTORY: A 6-year-old female presented to our clinic with a four-month history of asymptomatic flesh-colored papules along the intergluteal cleft. The patient’s mother denied any other involved areas. The patient denies any pain, tenderness, or itching of the lesions. The patient has a past history of intellectual delay, right lower extremity hypertrophy, syndactyly of the 2nd through 4th toes on the right foot, venous malformation involving the right lower thigh, knee, and proximal calf, and lichen striatus of the left lower extremity. The papules had been previously treated with over-the-counter cryotherapy without noticeable improvement. The patient follows closely with a vascular malformation clinic in San Antonio for her diagnosis of Klippel Trenaunay Syndrome. Past surgical history includes syndactyly release of the 4th toe. The patient denies constipation, diarrhea, fevers, chills, trouble sitting or standing, unwanted sexual activity, or use of fragrance wipes. No one in the household has similar lesions.

Rash Decisions: A Case of Persistent Pustules and Plaques in a Young Female

March 22, 2024

Presenter: Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have a rash all over my body and felt sick the past few days”

CLINICAL HISTORY: An 18-year-old Hispanic female presented to our clinic with diffusely spread, erythematous plaques and pustules covered by crusts, which had evolved over the past eight months. She denied any mucosal involvement but reported significant symptoms over the last three days, including difficulty walking, fever, skin tenderness, malaise, arthralgia, and headaches. Notably, no one else in her household exhibited similar lesions. The patient denied recent travel, sick contacts, alcohol use, illicit drug use, or smoking.

Spontaneous Bruising in a Young Female Patient

October 3, 2023

Presenter: Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I’ve been noticing random bruises appearing on my body ”

CLINICAL HISTORY: A 30-year-old Latin American female with a medical history of anxiety, hypotension, hypothyroidism, fibromyalgia, and arrhythmias presented to our clinic with episodic spontaneous bruising on both thighs, which had been occurring since February 2022. She reported pain upon palpation but did not have any other systemic symptoms. The patient denied any new medications or recent traumatic events. Her only surgical history included the placement of a cardiac loop recorder two years prior. She had no history of smoking, alcohol use, or illicit drug use. She denied any family history of bleeding or thrombotic disorders, skin cancer, or liver disease. Current medications included midodrine, fludrocortisone, levothyroxine, and diclofenac, and there were no known drug allergies.

Hyperpigmented Patch Mimicking Melanocytic Lesions

September 25, 2023

Presenter: Paul Vance, DO, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have a spot growing in size on my left hand”

CLINICAL HISTORY: An 11-year-old Hispanic female presented to our clinic for evaluation of a growing dark spot on the palm of her left hand. The patient states that the lesion has been present for the past several months and seems to be getting bigger. The patient endorses occasional itchiness, but no pain. No one else in the household had similar lesions. The patient denies any surgical history, medication use, allergies, recent travel, or personal or family history of skin cancer.

Exploring a Rare Chronic Nodule in the Extremity

September 25, 2023

Presenter: Eric Sandrock, DO, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have a hard lump on my finger ”

CLINICAL HISTORY: A 10-year-old male with no significant past medical or surgical history presents to our clinic for a solitary lesion overlying the distal left index finger. He describes it as “hard” and stated it has been present and stable for the past year. He denied any trauma to the area, restriction in range of motion, or tenderness to palpation. He denied any recent weight loss, fevers, or chills. He denied any personal or family history of similar lesions or skin cancer.

Hypopigmented and Atrophic Patch on Neck

March 24, 2023

Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have a pale spot on my neck”

CLINICAL HISTORY: A 14-year-old Hispanic female with a history of acne vulgaris presents to our clinic with concern for a hypopigmented, atrophic patch on the left side of her neck. Per the patient’s mother, she first noticed the lesion when she took the patient to the pediatrician a few days prior to this visit. The patient tried topical benzoyl peroxide-clindamycin gel on the spot that was prescribed for her back acne. She denied itching, pain, or systemic symptoms. She also denies recent travel, sick contacts, excessive sweating, smoking, alcohol, or illicit drug use. Patient denies any personal or family history of skin cancer.

Seemingly Innocuous Skin Findings: A Surprising Turn in Clinical Evaluation

September 26, 2024

Presenter: Eric Sandrock, DO, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “A new pimple grew on my arm ”

CLINICAL HISTORY: A 67-year-old male with a medical history of hypertension, coronary artery disease, non-melanoma skin cancers, lower esophageal adenocarcinoma, and intracranial arteriovenous malformations, presented to our clinic to discuss biopsy results from a lesion on his left cheek. The biopsy confirmed the presence of a nodular and pigmented basal cell carcinoma. During this visit, the patient also reported a new papule on his left proximal forearm, which he indicated had been present for only a few weeks. He denied any bleeding or discomfort associated with the new lesion.

Progressive Vascular Anomalies and Musculoskeletal Symptoms in an Adult Patient

September 26, 2024

Presenter: Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “I have many dark growths and bruises all over my arm ”

CLINICAL HISTORY: A 50-year-old male presented to our clinic with pain in his right hand and forearm that had been intermittently treated as cellulitis with oral antibiotics. The patient reported that he was born with a hemangioma on the right forearm, which has been growing in size and number over time. He denied trauma to the area and joint pain, but endorsed a limited range of motion affecting his daily activities. He also reports easy bruising. He denied any systemic symptoms, including fever, chills, shortness of breath, weight loss, and fatigue. He denied any history of recent travel or sick contacts. No other household members had similar lesions. His only pertinent surgical history was an excision of two subcutaneous lesions of the right antecubital fossa 20 years ago. The only medications the patient reported taking was gabapentin 300 mg BID.

Green-black discoloration of fingernails in a 70-year-old female

September 24, 2024

Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO

Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program

CHIEF COMPLAINT: “Two of my nails turned black ”

CLINICAL HISTORY: A 70-year-old female with no past medical history presented to our clinic with greenish-black discoloration of two fingernails on the right hand. She states she first noticed the color change three months ago after removing nail polish. She further states she goes to the nail salon regularly and was instructed to soak her nails in vinegar. She saw her primary care provider two weeks ago and was started on oral terbinafine. She reports no improvement in the discoloration. Patient denies pain, swelling, and discharge. She also denies a history of smoking, alcohol use, illicit drug use, or recent travel. Patient states she has no personal or family history of skin cancer.

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