Dermatology

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Navel battles!

The mother of a 7-month old boy was worried about a nontender, firm, irreducible lump that appeared on his navel 2 months ago.

Nail-Patella Syndrome

This 16-year-old boy with nailpatella syndrome (NPS) presented for routine follow-up. As an infant, he had surgical correction for clubfeet. For the past month, he had had intermittent bilateral foot and ankle pain and some knee and hip discomfort.

You are asked to evalute a fussy 6-week-old infant with a rash that started on her left axilla 3 weeks ago and spread to the left arm, chest, and abdomen.

This 14-year-old boy is brought for assessment and treatment of acne by his mother who is noted to have superficial acne scars. His 17-year-old brother has required systemic isotretinoin to control his acne, and the mother wishes to avoid any systemic therapy for her other son.

This 9–month–old boy was initially evaluated at age 6 weeks for an extensive eczematous rash on the head and antecubital and diaper areas and blood and mucus in the stool with each diaper change over a 2– to 3–week period. The symptoms were attributed to milk allergy, and the infant’s formula was changed. At 8 weeks of age, a petechial rash developed on the boy’s trunk and legs. His symptoms persisted despite multiple formula changes, and he was referred to the emergency department.

A 13-year-old boy from inner city Philadelphia presented with an infected “tattoo” on his right forearm. On examination, he had multiple hypopigmented scars on his extremities. When asked about the scars, the patient appeared embarrassed and stated that they were tattoos, which he created with an eraser from a pencil.

The mother of a healthy 21-month-old girl says that her daughter's unruly hair never lies flat on the scalp and cannot be tamed by combing or brushing.

This 8-year-old girl has had swollen, red eyelids for the past 24 hours. She denies pain or pruritus. She has had no eye drainage, fever, or other systemic signs of illness. She reports some mild fatigue for the past few months but denies myalgias or decreased muscle strength.

A 10-year-old boy had increasing irritation and itching of the lower legs for the past 5 weeks. The boy was an avid soccer player. Examination revealed an acutely inflamed, exudative dermatitis on the anterior aspect of both legs.

This 14-month-old girl was brought for evaluation of marked swelling and erythema of the left eyelids (A) The mother had noticed a green discharge and mild swelling of the eye 2 nights earlier.

I read with interest Drs Kumar, Noronha, and Leung's recent "What's Your Diagnosis?" case highlighting the common skin problem, keratosis pilaris. In my suburban pediatric practice, patients frequently ask me how to eradicate this benign but annoying condition.

This pigmented lesion has developed over the past 12 months on the posterior aspect of a 3-year-old boy's thigh. The lesion measures 5 mm and exhibits a dark black nodular center with a light brown pigmented periphery. The lesion is asymptomatic, and the child is well.

A 4-month-old girl is brought to your office by nervous parents who point out swelling of all the fingers of her right hand associated with tender, deep nodules on the proximal and middle phalanges.

The areas of hypopigmentation on this 4-month-old girl are sequelae of eczema. The rash had developed on the infant’s upper extremities in the bilateral antecubital and popliteal fossae at 1 month of age. Her cheeks were also affected, although only slightly. Her initial diet consisted of regular infant formula. This was switched to soy formula, which she vomited. She was then given a lactose-free formula, which she tolerated well.