Itchy Patches

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.

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Painful, Swollen Left Foot

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.

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Dyspnea, Hemoptysis, and Rash

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.

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Skin Rash on the Bilateral Upper Extremities and Face

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. 

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Progressive Worsening Rash

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.

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