2008-2009 Academic Year Archives - Dermatology Grand Rounds

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

Chief Editor — Fri, 26 Sep 2008 05:36:39 +0000

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.

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Blisters on arms and legs

Chief Editor — Tue, 26 Aug 2008 05:30:30 +0000

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.

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Multiple excoriations and erosions of the extremities

Chief Editor — Sat, 09 Aug 2008 05:26:36 +0000

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.

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Large yellow plaque on the tongue

Chief Editor — Sat, 26 Jul 2008 05:21:25 +0000

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.

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Sores on both hands

Chief Editor — Thu, 26 Jun 2008 05:18:48 +0000

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.

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Excess skin on hand and foot

Chief Editor — Thu, 26 Jun 2008 05:15:19 +0000

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.

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Multiple ulcerations and erosions on the dorsal aspects of hands

Chief Editor — Mon, 26 May 2008 05:11:18 +0000

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.

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Atypical rash on the right forearm

Chief Editor — Mon, 26 May 2008 05:06:22 +0000

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!

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Asymptomatic fibrotic lesion on the mid back

Chief Editor — Sat, 26 Apr 2008 05:02:41 +0000

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.

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Pruritic annular plaques

Chief Editor — Mon, 31 Mar 2008 04:58:43 +0000

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.

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