2016-2017 Academic Year Archives - Page 3 of 4

58yo female with hyperpigmented papules on arms and palms

November 27, 2016

Presenter: Olga Demidova, DO; Laura Jordan, DO; Cole Cahill, DO; Schield Wikas, DO; Monte Fox, DO

Dermatology Program: Tri-County Dermatology

CHIEF COMPLAINT: Asymptomatic hyperpigmented papules over arms and palms

CLINICAL HISTORY: A 58-year-old female was referred to the dermatology clinic by her primary care physician for evaluation of asymptomatic hyperpigmented papules involving her arms and palms. Growths appeared several weeks prior to the initial visit. During the visit, the patient reported mild shortness of breath that is chronic for her and may have worsened in the past few weeks. She denied changes in medications and any recent illness. No previous treatments to the papules. Her past medical history consisted of asthma, COPD, GERD, atrial fibrillation, breast cancer, hypertension, hypothyroidism, infantile seizures, and radiation treatments. Past surgical history included breast lumpectomy, breast biopsy, cholecystectomy, and hysterectomy. The patient denied any personal or family history of skin disease or skin cancer. Her medications at the time included atenolol, levothyroxine, flomax, hydrochlorothiazide, ibuprofen, and probiotics, and she admitted allergies to adhesive tape, voltaren, dolobid, vicodin, calan, lipitor, crestor, zetia, and simvastatin. Patient was a former cigarette smoker and denied alcohol use.

Worsening rash in female with history of cord blood transplant

October 27, 2016

Presenter: John Howard, DO

Dermatology Program: Larkin Community Hospital/NSU-COM, South Miami, FL

CHIEF COMPLAINT: progressively worsening pruritic rash on her extremities and trunk

CLINICAL HISTORY: A 12-year-old African American female with a history of immunodeficiency syndrome due to an NF-kappa-B essential modulator (NEMO) gene mutation, currently status post umbilical CBT before age 1 with myeloablation-induced hypothyroidism and hypoestrogenism, presented to Advanced Dermatology & Cosmetic Surgery in Margate, Florida as an outpatient complaining of a progressively worsening, pruritic, hypertrophic, and lichenified plaques and papules on truck and extremities for several months. The patient denies preceding or current upper respiratory infection, cough, sore throat, fever, chills, arthralgias, or diarrhea. She presents with recent negative bloodwork for South Florida environment allergy panel and negative T.R.U.E. allergy patch testing. Her only medications are levothyroxine 62.5mcg daily and estradiol 0.025 mg/hr weekly patch for Hashimoto thyroiditis-induced hypothyroidism and hypoestrogenism respectively. She has no known drug allergies. Family history is significant for an older brother who unfortunately passed away shortly after birth due to a NEMO mutation and the mother states she is the carrier. Patient has been using mild-potency topical steroid creams and oils and lotions.

Incidentally, her mother was noted to have dark brown hyperpigmented thin plaques in a blaschkoid distribution on bilateral posterior lower extremities. The mother refused a skin biopsy, which was explained could support the clinical impression of IP. Taken in total, mother and daughter share a mutation in NEMO, however, the mother’s phenotype is that of IP and the daughter’s phenotype that of anhidrotic ectodermal dysplasia with immunodeficiency (AED-ID).

Persistent nipple dermatitis

October 27, 2016

Presenter: Shannon McKeen, DO

Dermatology Program: MSUCOM/Lakeland Regional Medical Center

CHIEF COMPLAINT: Persistent rash on the right breast

CLINICAL HISTORY: A 63-year-old Caucasian female with a persistent rash on the right breast. In February of 2000, the patient underwent excision of ductal carcinoma in situ, a high nuclear grade with focal micro-invasion of the right breast. This was followed by eight weeks of radiation therapy and a five-year course of tamoxifen. She did not seek to follow up imaging until 2004, which had shown calcifications. Biopsy of the calcifications showed recurrent ductal carcinoma in situ. At that time, the surgeon recommended mastectomy with axillary lymph node dissection. The patient refused due to concerns over loss of function and swelling in the arm. In 2016, several months prior to her presentation in our office, the patient developed a rash on the right breast. The rash involved the areola and periareolar skin. The patient described the rash as red, itchy, and mild in severity. She was seen by her Gynecologist who gave her a topical corticosteroid cream, which helped improve the rash somewhat, only to return upon discontinuation. The patient also reported using a “diaper rash cream” which mildly improved her symptoms. The Gynecologist ordered a 3D mammography and subsequent ultrasound. Both reports were read as having dystrophic calcifications, recommending six months follow up exams. The patient was referred to our office for her persistent rash. At the initial consultation, we ordered an MRI of the right breast, referred her to the general surgeon who performed the initial excision in 2000, and the patient was given samples of flurandrenolide 0.05% cream to apply twice daily until follow up. The patient called several days later and refused MRI, as well as canceled the appointment with the general surgeon. She was instructed to return to the office for a biopsy.

15 year old with hair loss since 3 months of age

August 27, 2016

Presenter: Kevin Svancara, DO, Jonathan Bellew, DO

Dermatology Program: Advanced Desert Dermatology (MWU)

CHIEF COMPLAINT: Hair loss and thinning of the scalp

CLINICAL HISTORY: A 15-year-old female presents with diffuse hair loss and thinning of the scalp, with the most significant loss occurring on the posterior aspect. She reports that her scalp is flaking, itching, and burning, with these symptoms having persisted since she was three months old. The patient also notes that her hair breaks very easily. Additionally, she describes small, rough bumps on the backs of her arms and lateral legs that occasionally itch. Her past medical history includes bipolar disorder, and she is currently taking Depakote and using ketoconazole 2% shampoo. There is no significant family history, including any known family history of similar hair conditions, and she does not have information regarding her father’s family history. Socially, she is a student, does not smoke, and does not consume alcohol. She has no surgical history and no known drug allergies (NKDA). Previously, the patient has been treated for seborrhea with ketoconazole shampoo for several years, washing her hair twice daily. While some improvement in scalp scaling has been noted, there has been no improvement in hair loss or thinning.

Pruritic, tender lesions on lower legs

July 27, 2016

Presenter: Vukmer DO , Tyler O. Petrosian

Dermatology Program: Hackensack at Palisades UMC

CHIEF COMPLAINT: Pruritic, tender lesions on his lower legs

CLINICAL HISTORY: A 68-year-old Hispanic male presented complaining of a 2-year history of very pruritic, tender lesions on his lower legs. The patient also complained of a years-long history of arthralgia and asthma. Infectious disease treated suspected cellulitis with rocephin and vancomycin. There was no improvement in skin lesions. Family history was positive for asthma, arthritis, diabetes, and thyroid disorders. The only medical allergy was to percocet. Medications at the time of presentation were: aspirin 81mg po qd, levothyroxine 25mcg PO QD, lovastatin 10mg PO QD, metoprolol 50mg PO QD, and montelukast 10mg PO QD.