2017-2018 Academic Year Archives - Dermatology Grand Rounds

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

Chief Editor — Sun, 24 May 2020 13:37:31 +0000

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.

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Chronic axillary rash

Chief Editor — Mon, 28 May 2018 07:13:07 +0000

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.

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Multiple papules and nodules in female patient

Chief Editor — Thu, 17 May 2018 05:39:53 +0000

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.

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A man with vegetative plaques and oral erosions

Chief Editor — Sat, 17 Mar 2018 05:38:16 +0000

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.

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Generalized blisters after nivolumab treatment

Chief Editor — Wed, 07 Feb 2018 21:42:53 +0000

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.

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Growing lesion on the cheek of a 12-year-old female

Chief Editor — Thu, 07 Dec 2017 21:20:33 +0000

Presenter: Michelle Elway, DO

Dermatology Program: Colorado Dermatology Institute/Rocky Vista University

CHIEF COMPLAINT: new, growing lesion on her left cheek

CLINICAL HISTORY: A 12-year-old female was referred to our office by her Pediatrician complaining of a new, growing lesion on her left cheek. The patient and her mom reported that the lesion appeared approximately one month prior as a small reddish spot, which has since grown significantly. The patient denied changes in color, bleeding, ulceration, pain, pruritis, or crusting of the lesion. She also denied any systemic systems. They had no other concerns at that time. No previous treatments. The patient had no past medical history to note. Family history was non-pertinent.

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A 32 year old male with a growth on his back

Chief Editor — Sat, 04 Nov 2017 07:08:45 +0000

Presenter: Ryan T. Jones, DO

Dermatology Program: MSU/Lakeland Regional Medical Center

CHIEF COMPLAINT: A itchy, irritated growth on the back.

CLINICAL HISTORY: The patient is a 32-year-old male who presented to our clinic with a complaint of a growth on his back which had been present for one year only. The growth is irritated and itchy but is not tender or painful. Over the course of the year the lesion has very slowly enlarged with increased itch/irritation. The patient denied any changes in color or shape since he first noticed the lesion. He also denied any other concurrent skin findings or rashes since onset. No previous treatments. He denies any previous personal or family history of skin cancer, autoimmune, or rheumatologic disease. He denies having any known medical problems other than seasonal allergies, has not had any surgeries, has no significant family history, and denies any known allergies.

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Pigmented papulonodular rash following axillary lymphadenectomy

Chief Editor — Sat, 30 Sep 2017 08:46:21 +0000

Presenter: Jonathan Bellew, DO

Dermatology Program: Advanced Desert Dermatology

CHIEF COMPLAINT: Violaceous hyperpigmented rash on the right upper body

CLINICAL HISTORY: A 79-year-old Caucasian male presented to the outpatient office setting with a six-month history of progressive asymptomatic violaceous-black pigmented papules, plaques, and nodules of the right shoulder, axilla, chest, upper abdomen, and lateral trunk. The patient denied systemic complaints, pain, pruritis, or discomfort. Two months prior to the skin eruption the patient underwent primary resection of a right mid-back malignant melanoma. The melanoma was histologically classified as superficial spreading and nodular type with a Breslow’s thickness of 1.4 mm and Clark’s level IV, with no ulceration, lymphovascular invasion, or satellitosis. Sentinel node biopsy showed extension to the right axillary lymph nodes prompting axillary lymphadenectomy.

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Eighty year old female with chronic lymphedema in left lower extremity

Chief Editor — Wed, 27 Sep 2017 08:05:35 +0000

Presenter: Victoria Comeau, D.O., Alexandria Glass, D.O., Caitlin Porubsky, D.O., Carmen Julian, D.O., Marcus Goodman, D.O.

Dermatology Program: PCOM Dermatology Residency

CHIEF COMPLAINT: “spot” on the left leg

CLINICAL HISTORY: 80 year old female presented with a “blue” golf ball sized lesion which appeared on her left leg about 1.5 years ago and has gradually enlarged. No previous treatments. The patient has a past medical history of coronary artery disease, type 2 diabetes mellitus, depression, hypertension, and severe left leg lymphedema. Her lymphedema started in the 1960’s after a radical total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) secondary to cervical cancer. Her lymphedema had been stable, but progressed over the last few years.

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Suspicious papules on nose, chest and back

Chief Editor — Wed, 27 Sep 2017 05:04:03 +0000

Presenter: Angela Macri DO, Christopher Cook DO FAOCD, FAAD, Jonathan Crane DO FAOCD, FAAD

Dermatology Program: Sampson Regional Medical Center

CHIEF COMPLAINT: new lesions that appeared on her nose, chest, and back

CLINICAL HISTORY: A 41 year old Caucasian female presented to our dermatology clinic for new lesions that appeared on her nose, chest, and back over the past year. The lesions were not changing in size, were not painful or pruritic, and have not bled. No prior treatments. Her past medical history included colon cancer diagnosed at age 21, depression, GERD, squamous cell carcinoma of the vulva, and basal cell carcinoma diagnosed at age 25. Surgical history included total hysterectomy, colectomy, vulvectomy, and cholecystectomy. Her family history on her paternal side included colon cancer diagnosed in her father, grandfather, aunt, and two uncles. Her paternal aunt was diagnosed with breast cancer.

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