2014-2015 Academic Year Archives - Page 2 of 4

Nodule on the vertex of the scalp

February 27, 2015

Presenter: Stephen Hemperly, DO

Dermatology Program: Lehigh Valley Health Network

CHIEF COMPLAINT: 1-year history of a nodule on the vertex of the scalp

CLINICAL HISTORY: Our patient is a 71-year-old Caucasian male who presented with a one-year history of a nodule on the vertex of the scalp. The lesion had become soft and tender during the week prior to the presentation. He admitted to headaches and a buzzing sound in his head. He denied all other neurologic symptoms. The patient was given amoxicillin from a primary care physician and was referred to us for excision of a presumed inflamed cyst.

Sudden onset of pruritic papules

January 27, 2015

Presenter: Douglas M Richley, DO

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: Initial evaluation of a generalized, pruritic eruption

CLINICAL HISTORY: A 44-year-old obese Caucasian male presented for initial evaluation of a generalized, pruritic eruption. The eruption had been present for approximately three weeks, beginning on his elbows and subsequently spread to involve his back, abdomen, knees, and posterior thighs. The patient denied recent illness or changes in medications and also admitted to having frequent bouts of blurry vision over the past couple of weeks. No previous treatments.

New onset eyebrow alopecia

January 27, 2015

Presenter: Matthew Koehler, DO

Dermatology Program: OPTI-West/College Medical Center

CHIEF COMPLAINT: Losing hair in his left eyebrow over a three week period

CLINICAL HISTORY: A 42-year-old Caucasian male presented to our clinic with a chief complaint that he was losing hair in his left eyebrow over a three week period. Before the onset of hair loss, he states he has noticed an enlarging “pimple” or “bite” growing under his eyebrow. The lesion was not painful and had no associated itching or burning sensation. He was, however, concerned with the aesthetics of the lesion and the possibility of continued growth. The patient has tried a mixture of hydrocortisone and clotrimazole cream to the area twice daily for the last week. During the first two weeks, the patient had tried cool compresses, but no treatments had any effect on the lesion. Family and social history are non-contributory.

Female with facial swelling

November 27, 2014

Presenter: D. Ryan Skinner DO, Gina Caputo DO

Dermatology Program: Lewis Gale Hospital Montgomery

CHIEF COMPLAINT: Bilateral swelling to the face

CLINICAL HISTORY: A 29-year-old female with a history of type 2 insulin-dependent diabetes mellitus presented to the clinic with bilateral facial swelling that had been present for approximately a year and a half. She has had an extensive workup and been seen by her PCP, as well as allergy, ophthalmology, and rheumatology with no clear etiology being found. Her facial edema is generally always present, but waxes and wanes in its severity. Previous treatment includes doxycycline 100mg twice a day.

Spreading rash from left wrist

November 27, 2014

Presenter: Maren Gaul DO, Nathan Jackson DO

Dermatology Program: Western Reserve Hospital/Tri-County Dermatology

CHIEF COMPLAINT: Spreading rash from the left wrist (present for 11 months) to bilateral upper and lower extremities

CLINICAL HISTORY: 17-year-old Caucasian Female presented with complaint of spreading rash from the left wrist (present for 11 months) to bilateral upper and lower extremities in last week since biopsy of the wrist. The patient initially noted a rash on her left wrist in October 2013, which worsened on July 13, 2014. She admitted to pruritis and tenderness of the area of the left wrist with the involvement of the rash.

In July she went to minute clinic and was diagnosed with impetigo and given oral clindamycin for 2 days. She then went to urgent care, was diagnosed with poison ivy, and given prednisone, with some improvement. She also had received hydrocortisone valerate 0.2% and triamcinolone acetonide 0.5% as past therapy. Initial assessment at Tri-County Dermatology yielded a punch biopsy for H&E, which will be discussed below. She was also given halog 0.1% cream and a z-pak. Medical history and surgical history were negative. There were no recent infections, recent travel, or exposures to any new drugs or chemicals other than her previous treatments, and ROS such as arthritis, arthralgias, fever, or systemic involvement was negative.