2013-2014 Academic Year Archives - Dermatology Grand Rounds

Multiple flesh colored papules on face and trunk

Chief Editor — Fri, 27 Jun 2014 03:38:39 +0000

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.

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Multiple asymptomatic “white” patches

Chief Editor — Fri, 27 Jun 2014 03:29:23 +0000

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.

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Ulcerative lesions in returning travelers

Chief Editor — Tue, 27 May 2014 03:06:24 +0000

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.

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Pruritic, painful callus on the toe

Chief Editor — Thu, 27 Mar 2014 02:58:11 +0000

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.

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Rash with occasional small blisters

Chief Editor — Thu, 27 Mar 2014 02:55:51 +0000

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.

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

Chief Editor — Mon, 27 Jan 2014 02:52:12 +0000

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.

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Rapidly expanding necrotic plaques in an elderly woman

Chief Editor — Mon, 27 Jan 2014 00:25:39 +0000

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.

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A 53-year-old male with pruritic red papules

Chief Editor — Fri, 27 Dec 2013 00:21:34 +0000

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.

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Facial “acne” that has been present for entire life

Chief Editor — Fri, 27 Dec 2013 00:18:04 +0000

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.

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Sudden purpuric rash on the lower legs

Chief Editor — Wed, 27 Nov 2013 00:14:29 +0000

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.

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