2019-2020 Academic Year Archives - Dermatology Grand Rounds

Rare Inherited Skin Disorder Initially Misdiagnosed as Psoriasis

May 24, 2020

Presenter: Sarah Hocker, D.O. and Lauren Dozier, D.O.

Dermatology Program: Larkin Community Hospital, South Miami, FL

CHIEF COMPLAINT: A 12-year-old male with a history of blindness in his left eye, presented to our clinic for evaluation of an itchy, scaly rash on his body, face, and scalp.

CLINICAL HISTORY: The patient states that the rash had been present for 5 years now, and is worsening. He admits to itching but denies pain. The patient reports previously seeing a dermatologist a few years ago that performed two punch biopsies that came back as severe plaque psoriasis. He denies a family history of a similar rash. He tried lactic acid creams, urea cream, numerous topical and intralesional corticosteroids and pimecrolimus.

Patient with a 5 year long history of brown macule on left zygoma

May 20, 2020

Presenter: Soham Chaudhari, DO, Carlos Rivera, MD, Thomas L Davis, MD Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency program

CHIEF COMPLAINT: Brown solitary macule on the left cheek

CLINICAL HISTORY: A 38-year-old female with no past medical history who was referred to our dermatology clinic from her PCP for a lesion that has been present for 5 years. The patient denies any surgical history, medication use, allergies, or any type of family history of skin cancer. The patient also denies smoking, drinking alcohol, or use of illicit drugs.

Rare Lesion On a 9-Month-Old Infant

December 6, 2019

Presenter: Jeffrey Harbold, DO, Carlos A. Rivera MD, Rick Lin, DO

Dermatology Program: South Texas Dermatology Residency Program, HCA Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨My son has a rare lesion on his left arm”

CLINICAL HISTORY: A 9-month-old Hispanic male with an evolving asymptomatic linear atrophic plaque on the flexor surface of the left wrist extending to the left upper arm. The patient’s Mother reports the presence of lesion at birth. She also reports that the lesions have progressed in a linear pattern towards the proximal arm. The patient has a history of pyloric stenosis s/p pylorectomy, macrocephaly, and patent foramen ovale/peripheral pulmonic stenosis(PFO/PPS). No significant dermatological family history was reported, including history of skin cancer. At 5 months of age, the patient underwent a MRI Brian for the history of macrocephaly which demonstrated enlargement of the subarachnoid spaces. Echocardiogram was performed during infancy for the history of PFO/PPS that was otherwise normal.

Pink papules on both arms

October 8, 2019

Presenter: Jeffrey Harbold, DO, Carlos A. Rivera MD, Rick Lin, DO, Michael Hohnadel, DO, Thomas L Davis, MD

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨I have skin lesions on both arms”

CLINICAL HISTORY: A 45-year-old Hispanic male with a past medical history of Down syndrome was referred to our clinic with an 8-year history of numerous crops of hyperpigmented confluent smooth papules. Lesions originated on the flexural surfaces of both arms with subsequent spread to the lower torso and legs, with facial sparing. The patient reported occasional mild pruritus but denied any associated pain. Other dermatologic history include biopsy-confirmed scabies in 2015 successfully treated with topical permethrin and a history of rosacea controlled with metronidazole gel and an occasional oral minocycline. There was no significant dermatologic family history reported.

Rare skin and muscle lesions

August 9, 2019

Presenter: Christine Ku, DO; Michael Hohnadel DO; Rick Lin DO; Michael Sedrak MD.

Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center

CHIEF COMPLAINT: ¨I have a rash and other lesions on my fingers”

CLINICAL HISTORY: The patient is a 23-year-old female who presented to the clinic with a complaint of diffuse skin rash and ulcerations. She reported symptom onset about 12 months ago, with worsening of symptoms in the past 4-6 months. Symptoms began with cuticle inflammation consisting of redness and pain. She saw her primary care physician who prescribed topical therapy with some improvement. A few weeks later she noted wrist pain and swelling followed by the progressive development of diffuse arthralgia and arthritis in fingers, hands, and knees. The patient then described onset of a rash over thighs and buttocks which then spread to her torso and extremities. She described the rash as pruritic and slightly painful. This was followed by the development of skin ulcerations resulting in open, non-healing wounds on extremities as well as digital ulcers on hands and oral ulcers. Of note, the patient also reported an unintentional weight loss of 20 pounds over the past year (over 15% of her initial body weight). The patient denied fevers, change in vision, shortness of breath or chest pain, or other systemic symptoms. The patient was evaluated by rheumatology who trialed prednisone, methotrexate injections, and Plaquenil with some improvement in symptoms. The patient had no other significant medical or surgical history, was previously not taking any medications. It was noted that she had a positive family history of lupus in her maternal aunt and cousin.