Bskirk Barber, MD, FRCPC

In this age of evidence-based medicine and randomized clinical trials, it is easy to forget that careful clinical observation and documentation are the foundation of medical practice.

This 13-year-old girl, who has just entered secondary school, has been devastated by the appearance of psoriatic plaques on her scalp. She states that her peers shun her and make rude comments about the "scabs" on her face

This 9-year-old girl has extensive psoriasis and is currently receiving narrowband UVB phototherapy for her body plaques. Her mother has insisted on covering her daughter's face during treatment and on having the girl use sunscreen on her face whenever she is outdoors to prevent premature aging.

This teenager had been taking penicillin for a sore throat about 2 weeks before this rash developed. Her pediatrician thought that the rash was a drug reaction and had her discontinue the medication. Nevertheless, the rash persisted for more than a month after therapy was stopped.

This boy has had areas of hypopigmentation around his eyes, mouth, and nose for the past 2 years. He has been applying a topical corticosteroid to the affected area, but new lesions continue to develop.

Infantile seborrhea has many of the features of the other papulosquamous conditions listed, but the diagnosis is most commonly clinically evident on examination alone. If you are unsure, a KOH preparation will quickly sort out the dermatophytes. Also, the lack of itch makes atopic dermatitis very unlikely.

This rash has developed over the past few months in a 4-month-old girl. The infant does not seem to be bothered by it. Her mother thinks that the rash started a few days after a family picnic.

A teenaged boy presented with this large, light brown pigmented macule that developed after he returned from a vacation with his family in Florida. He takes no medications and has been healthy.

A 17-year-old boy presents with a red, scaly rash on his trunk that began as a single lesion on his left flank. The generalized eruption had developed within 24 to 48 hours. The patient's father has psoriasis.

A 16-year-old boy complains of an itchy scalp and areas of hair loss. Physical examination reveals a 2- to 3-cm patch of alopecia studded with black dots, as well as posterior cervical and occipital lymphadenopathy.

This 7-year-old boy was recently brought to my office having received a diagnosisof pemphigus foliaceus. His parents were seeking a second opinion.

This infant's mother noted the development of 2 reddish-pink firm papules on her son's forehead when he was about 1 month old. These are the only lesions present, and they are asymptomatic. The only change in the lesions has been their color, which is now yellow-orange.

This 13-year-old boy plays basketball for his school team. His mother brings him to your office and asks you about her son's toenail that has changed appearance and now looks like his father's great toenail. The father has psoriasis.

This 7-year-old boy was recently brought to my office having received a diagnosis of pemphigus foliaceus. His parents were seeking a second opinion.

I was asked to see this child by her physician who was concerned that these lesions were a neoplastic event. The physician wanted a dermatologist's opinion and a biopsy to guide treatment decisions. Needless to say, the child's parents were distraught. The child was happy, playful, and not at all disturbed by the rash.

A white ring recently developed around this lesion on the upper back of a 15-year-old boy. Is there any reason for concern--and what clues would you use to suggest the need for a biopsy?

This asymptomatic plaque on the left cheek of a 12-year-old girl was not respondingto a cream that her physician had prescribed when the rash began.

This lesion has developed over the past 6 months on a 6-year-old's nose. It measures 3 mm and is reddish brown with a regular border.