2011-2012 Academic Year Archives - Dermatology Grand Rounds

Pruritic, purple plaques on the legs and axilla

Chief Editor — Tue, 26 Jun 2012 20:46:18 +0000

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.

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Tender plaques of the trunk

Chief Editor — Tue, 26 Jun 2012 20:41:30 +0000

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.

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Hyperpigmented blistering lesion in a 13 yo female

Chief Editor — Sat, 26 May 2012 20:38:07 +0000

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.

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Generalized rash

Chief Editor — Mon, 26 Mar 2012 20:31:50 +0000

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.

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Multiple friable nodules on back

Chief Editor — Thu, 26 Jan 2012 20:26:31 +0000

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.

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Hyperkeratotic plaques on the lower extremities

Chief Editor — Mon, 26 Dec 2011 20:19:57 +0000

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.

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Progressive stiffening of skin

Chief Editor — Sat, 26 Nov 2011 20:17:01 +0000

Presenter: Kate Kleydman, DO

Dermatology Program: Saint. Barnabas Hospital

CHIEF COMPLAINT: "My skin is so stiff."

CLINICAL HISTORY: A 52-year-old African-American female presented with complaints of having “stiff skin” that progressively impaired her movement over the past five years. The skin “tightness” had started on the body, and then progressed to include her hands, trunk, legs, and finally face. She complained of constant pain, with restrictions of movement requiring the use of a walker. She experienced worsening of the pain in her hands, accompanied by color changes and tingling in cold weather. Her review of systems was positive for difficulty swallowing, acid reflux, dyspnea on exertion, nonproductive cough, diffuse arthralgias and myalgias, subjective decreased range of motion, and chronic fatigue. No previous treatment. Her past medical history was significant for hypertension and gastroesophageal reflux disease. The patient was taking Lisinopril and Percocet and denied alcohol and drug use. Her family history was negative for any significant dermatologic diseases or autoimmune disorders.

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Hyperpigmented macules and papules on trunk and extremities

Chief Editor — Wed, 26 Oct 2011 20:04:28 +0000

Presenter: Aleksandra Brown, DO

Dermatology Program: POH/Botsford

CHIEF COMPLAINT: Rash x 1 year

CLINICAL HISTORY: A 23-year-old female presents for evaluation of multiple hyperpigmented macules and papules on her thighs, arms, chest, and abdomen. They have been present for approximately one year and are mildly pruritic. A review of systems reveals fatigue for two weeks. She has no significant past medical history and family history is non-contributory. She does report an allergy to bee stings.

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Lesions on the neck

Chief Editor — Mon, 26 Sep 2011 20:01:35 +0000

Presenter: John Stoner, D.O.

Dermatology Program: PCOM

CHIEF COMPLAINT: asymptomatic persistent “rash” on the neck and axillae

CLINICAL HISTORY: The patient presented to our office complaining of an asymptomatic “rash” on the neck and axillae that has been present for a few years. The lesions do not wax or wane. No itching, burning, or bleeding. The lesions are getting more red. No previous treatment.

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Unremitting rash on the feet

Chief Editor — Fri, 26 Aug 2011 19:31:51 +0000

Presenter: Robert Levine, DO, Tara Whelan, DO, Suzanne Sirota-Rozenberg, DO, FAOCD

Dermatology Program: St John's Episcopal Hospital, Far Rockaway, NY

CHIEF COMPLAINT: "Rash on the feet"

CLINICAL HISTORY: A 71-year-old male presented for follow up in a busy dermatology practice. He was being treated for about 6 weeks for suspected psoriasis with minimal improvement. He had mild pruritis and the rash seemed to be spreading. Previous treatments by prior physician include topical steroids (mid-high potency), topical calcipotriene, and topical antifungals. He had no other contributing skin lesions. He is of Jewish Ashkenazi descent.

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