2008-2009 Academic Year Archives - Page 2 of 2

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.