Dermatology

You are called to the emergency room to see an ill-looking, 13-year-old boy with a severe flare of his atopic dermatitis associated with fever, malaise, and chills, which started a week ago.

The worried mother of a 4-week-old boy brings her son to you for evaluation of a rash that started 3 weeks ago on his left eyebrow and chest, then spread to his back, arms, and legs despite treatment with topical steroids. What’s your diagnosis?

The frightened mother of a vigorous, healthy 14-day-old girl brings her daughter to you for an urgent consultation regarding a facial rash that has blossomed since a few subtle spots were noted at birth. What’s your diagnosis?

A healthy adolescent boy asks you to cure an itchy and painful rash on the nape of his neck that began over a year ago when he switched barbers. What’s your diagnosis?

The mother of a healthy 8-month-old boy pops into your office for an urgent visit seeking advice on a golden brown bump on her son’s lower back, visible since 2 months of age. This morning when he awoke, it appeared angry, red, and swollen although the swelling seems to be improving. What’s your diagnosis?

You are asked to evaluate a 10-year-old girl for peculiar annular eruptions on her hands and feet following treatment for warts 6 weeks ago. What could be causing these eruptions?

You are called to the emergency room to evaluate a healthy 2-year-old boy with black spots on his legs that were noted yesterday evening. His younger brother developed similar black spots this morning. The boys are healthy, and the lesions are not symptomatic and appear to be superficial.

Acne flare-ups in adolescents respond best to treatment when patients and parents understand what acne is, follow their therapy guidelines, and have reasonable expectations about what therapy can achieve.

A 2-month-old infant had right submandibular swelling with inflammation and induration up to the nape of neck. Ultrasonography showed multiple enlarged lymph nodes with soft tissue swelling. Blood cultures grew Gram-positive cocci, which were identified as group B streptococci. Late-onset GBS infection is acquired from colonized household contacts.

You care called to the emergency department to evaluate a 4-month old girl with multiple areas of purpura, including a distinctive bruise on the later aspect of the left thigh. The child's mother states that she noticed these lesions after picking up the infant from her biologic father, whose was watching the child alone. No trauma history is reported. The child has been otherwise in good health, with no signs of infection.

The parents of a 15-day-old boy who returned for his 2-week checkup are worried about a firm, glistening papule on his abdomen that has been present since birth. The patient is otherwise healthy, but the parents are seeking reassurance. A pediatric dermatology referral was quickly placed.

Test your skills in this 5-question quiz.QUESTION 1: A 16-year-old boy presented with an extremely pruritic rash on the elbows, at the wrists, and on the top of the hands. This is classic for granuloma annulare.  Courtesy of Ted Rosen, MD

The worried parents of a health 10-year-old girl ask you to evaluate her for a total-body red rash associated with scaling and edema.

This annular configuration is classic for granuloma annulare; very widespread lesions may signal diabetes mellitus.

A 6-month-old girl was brought to the ED with fever, cough, and irritability; she appeared well-hydrated. She was born prematurely and had a long, complicated stay in NICU, where she received CPR on 2 occasions. There was concern about lung "congestion." The ED physician made a diagnosis of pneumonia. Rib fractures were also noted, but there was no history of fractures at the time of discharge from the NICU.

Acrodermatitis enteropathica and Langerhans cell histocytosis are recalcitrant forms of diaper dermatitis( DD); other variants are: candidal DD, irritant or contact DD, Jacquet’s disease, and psoriasis.

Take this week's quiz and test your diagnostic and therapeutic skills.

Take this week's quiz and test your diagnostic and therapeutic skills.

The morphology and distribution of these lesions is characteristic of ectoparasite bites, which occur when a human carries a pet-usually a kitten or puppy-as if the animal were a human newborn baby.

You are called to the emergency department to evaluate a 2-year old boy with a fever for 5 days and a rapidly spreading rash on his face, arms, and legs for 2 days. The rash was made up of 3-mm to 6-mm diameter elongated vesicles on a red base. He is irritable and not eating well. There was another child at his day care with a similar rash, and his mother is worried that his 8-month old brother will develop the same illness.

The black, hard center represents an eschar. This type of morphology is almost always caused by a virulent organism-bacterial or fungal. Biopsy showed non-septate hyphae within the dermis, and a culture grew Mucor species (a saprophytic soil fungus).

Bell palsy is a facial nerve palsy thought to be the result of a lower motor neuron lesion caused by an autoimmune response. Viral infections are commonly implicated.

This child's mother was worried that these lesions were sexually transmitted. What's your suspicion?

The mother of this 4-year-old girl was concerned that these lesions were sexually transmitted. The physician recognized them as molluscum, but was uncertain of the potential relationship of this rash to child abuse.

The father of a healthy 3-year-old girl begs you to help with a bleeding bump on her left cheek. It has been present for a few weeks but in the last 2 days has bled profusely on 3 occasions for more than 30 minutes each time.

Acute hemorrhagic edema of infancy is a relatively uncommon form of leukocytoclastic vasculitis. Henoch-Schönlein purpura is the primary differential diagnosis.

In this 10 minute video, Dr. Ted Rosen addresses the following questions. A brief synopsis of Dr. Rosen’s comments follows.

A Hill-Sachs deformity is a compression injury to the posterolateral aspect of the humeral head created by the glenoid rim during dislocation.

The multiple erosions on this teenager's lip are most likely an exaggerated version of herpes labialis related to his underlying lymphoma. A viral culture would be useful to verify the diagnosis.