2017-2018 Academic Year Archives - Dermatology Grand Rounds

Pruritic blistering eruption on the forearms of a 60 year old male

May 24, 2020

Presenter: Courtney N. Bernett, DO, Logan Kolb, DO, and Shawn Schmieder, DO

Dermatology Program: Orange Park Medical Center/Park Avenue Dermatology

CHIEF COMPLAINT: ¨Itchy sore blisters on forearms”

CLINICAL HISTORY: A 62-year old male was referred to the dermatology clinic by his primary care physician (PCP) for a blistering rash on his arms. Three months prior to his presentation, he started to develop severe pruritus on his bilateral forearms. Shortly after the pruritus started, he developed large, blood-tinged blisters on his forearms. These blisters would rupture, leak fluid, and dry up. The patient saw his PCP for his blisters and they suspected a drug reaction to Lisinopril which had recently been started prior to his rash. His lisinopril was discontinued and changed to metoprolol with no change in his blisters. No topical treatments were attempted at that time. The patient has a past medical history of diabetes mellitus type 2, hypertension, and gastroesophageal reflux disease. He denied a personal or family history of hepatitis B or C, autoimmune disease, irritable bowel disease, or a history of recent travel. He has no known allergies, and his medications include metformin 500mg QD, metoprolol succinate 50mg QD, and omeprazole 40mg QD.

Chronic axillary rash

May 28, 2018

Presenter: Jessica Kim DO

Dermatology Program: Palm Beach Consortium Graduate Medical Education

CHIEF COMPLAINT: Chronic bilateral axillary rash which developed over the course of a year

CLINICAL HISTORY: Patient presented with an asymptomatic rash localized to the axillae. Patient has tried changing deodorants and using talcum powder without improvement. Past medical history includes diabetes mellitus (HgA1c 6.2), hypothyroidism, stasis dermatitis, hand eczema and hypertension. Pt denies use of tobacco or illicit drugs. He is currently on levothyroxine, carvedilol, pregabalin, saxagliptin, tamsulosin, pantoprazole, glipizide, warfarin, lisinopril, metformin, and furosemide. His allergies include acetaminophen, morphine, hydromorphine, zocor, and niaspan.

Multiple papules and nodules in female patient

May 17, 2018

Presenter: Danielle Raffaella Lazzara, DO

Dermatology Program: Larkin Community Hospital Palm Springs

CHIEF COMPLAINT: 1 year history of multiple, brown lesions diffusely spread on body.

CLINICAL HISTORY: 66 year-old Hispanic female presented with a 1 year history of multiple, brown lesions located to the neck, chest, and upper back. The lesions were noted to be stable and asymptomatic with no aggravating factors. Patient denied fever, chills, arthralgia, weight loss, cough, shortness of breath, uveitis, back pain, abdominal/pelvic pain, hematuria, and dysuria. No previous treatment was performed. Patient’s medical history is significant for hypercholesterolemia managed medically with a statin and uterine fibroids for which she had a hysterectomy at age 33. She denies any pertinent family history.

A man with vegetative plaques and oral erosions

March 17, 2018

Presenter: Carl Barrick, DO and Tanya Ermolovich, DO

Dermatology Program: Lehigh Valley Health Network/PCOM

CHIEF COMPLAINT: vegetative plaques right axilla, umbilicus, bilateral inguinal folds and scrotum with extension to anus

CLINICAL HISTORY: 34 year-old Caucasian male with vegetative plaques right axilla, umbilicus, bilateral inguinal folds and scrotum with extension to anus. The patient presents with ulceration and crusting of his nose and lips for six weeks. He has had thick, crusted lesions and swelling of his scrotum for three months. The lesions are asymptomatic although the ulcerations in his mouth are painful. He admits to feeling well without fevers, chills, dysphagia, diarrhea, abdominal pain, or joint pain. No previous treatment to lesions.

Generalized blisters after nivolumab treatment

February 7, 2018

Presenter: Alyson Ridpath, DO

Dermatology Program: OhioHealth O’Bleness

CHIEF COMPLAINT: new-0nset severe, pruritic, bullous eruption

CLINICAL HISTORY: A 67-year-old male with stage IV BRAF- and c-Kit-negative, NRAS-positive melanoma of unknown primary with metastases to the liver, lung and brain was started on nivolumab 3 mg/kg every two weeks. After 16 cycles over 32 weeks, he presented to the emergency department with a new, severe, pruritic, bullous eruption covering approximately 90% body surface area, and altered mental status. He was started on 1 mg/kg prednisone daily and betamethasone diproprionate 0.05% cream twice daily with the intention of restarting nivolumab after the steroid taper. His course was complicated by bacteremia and an inability maintain his BP on low dose corticosteroids. The inability to taper the patient to low dose steroids to disinhibit cellular immunity was a therapeutic challenge.