Dermatology

A thriving boy was brought to the office 3 weeks after his first birthday. His mother reported that there was "something wrong with his knee." On visual examination, the knee appeared perfectly normal. On palpation, however, a 4-cm linear induration was evident over the knee fat pad, just medial and distal to the patella. It appeared soft, crepitant, and associated with the skin. No tenderness was noted on palpation; the infant did not object to palpation of this density any more than to auscultation, otoscopy, or anthropometric measurements. No erythema, ecchymosis, or signs of trauma were evident near the lesion. The only possibly relevant history was that the child had spent his birthday at his grandmother's home in the Ukraine a month earlier. He was constantly with his mother during that time, and no trauma was ever reported.

Eight-year-old girl with mass in midline of neck.Mass first noted about 6 months earlier. Patient is otherwise well; past health unremarkable. No symptoms ofhypothyroidism.

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 23-month-old girl was brought to the pediatrician's office by her mother who was concerned about "bulging down there." The child's mother reported that a "bump" had been present in the girl's diaper area since her birth and that it had been growing.

This toddler has had abnormal-looking eyes since birth.What is this condition--and how common is it? Might this ocular malformation be associated with any other findings?

This 6-month-old boy was born with a pigmented hairy nevus that covered about 80% of his body surface. Multiple pigmented satellite lesions were also present.

Foreign-body aspiration is a relatively common occurrence in children. It may present as a life-threatening event that necessitates prompt removal of the aspirated material. However, the diagnosis may be delayed when the history is atypical, when parents fail to appreciate the significance of symptoms, or when clinical and radiologic findings are misleading or overlooked by the physician.

I appreciated the excellent photograph of cutaneous leishmaniasis thatCPT Kenneth Brooks recently contributed to Photoclinic (CONSULTANT, June2004, page 1018, Figure).

What's the cause of a hyperpigmented patch on an adolescent boy's back?

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.

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2Z\x weeks earlier, when he was hit in the face by a baseball. The sharply defined, slightly elevated, pink macule had fine papules with an annular flat area at its inferior central aspect. A potassium hydroxide preparation of scrapings from the lesion was negative for hyphae. However, fungus culture grew Cladosporium species.

Photoclinic: Langerhans Cell Histiocytosis

A 3-month-old infant presented with a 4-week history of a symmetric skin eruption on her face, axillae, distal extremities, and external genitalia. The infant was otherwise healthy, although colicky since birth. She was exclusively breast-fed and had a good appetite. Voiding and stooling patterns were normal. Her growth was appropriate for age.

A 16-year-old girl presented to the emergency department (ED) with a 24-hour history of feeling tired and weak. The patient reported that she awoke that morning with the "worst headache of her life" and "passed out" while sitting on the edge of her bed. She did not tell her friends or family.

A 12-year-old girl presents with a 1-year history of itchy lesions on her right leg. The lesions are worse during the winter. She has a history of atopic dermatitis and asthma.

Patient delivered vaginally at term to a G2P1 24-year-old mother following an uncomplicated pregnancy. Apgar scores, 7 and 9 at 1 and 5 minutes, respectively. No history of maternal exposure to teratogens. Parents non-consanguineous. No family history of congenital or chromosomal abnormality.

An 8-year-old boy whose family had recently immigrated from Southeast Asia was brought to the emergency department (ED) with a well-demarcated, pruritic rash that had appeared on his face 6 weeks earlier. At that time, the patient's primary care physician had diagnosed Fifth disease. As the rash spread to the child's arms and back, atopic dermatitis was considered. The week before presentation in the ED, the rash had become more inflamed and pruritic and was accompanied by fevers.

A recent study by researchers at Dana-Farber Cancer Institute and Children's Hospital Boston has raised the possibility that scientists may be able to develop an effective means of protecting fair-skinned people from skin cancer caused by exposure to sunlight. The research involved "tanning" specially engineered red-haired, light-skinned mice by applying a cream that activated their skin cells' tanning mechanism. Although the tan-inducing compound used on the mice has not yet been tested in humans, the findings suggest that medicinally induced tanning likely can occur in people who do not normally tan well and are, therefore, deprived of a tan's protective qualities.

An adolescent girl complains of headaches and presents with lateral-gaze paralysis of the right eye. Can you solve this mystery?

Ten-day-old boy born vaginally at 37 weeks breech without complications. Has history of poor feeding with vomiting and has lost weight since birth. One episode of vomiting described as projectile. Ultrasonography ruled out pyloric stenosis but revealed bilateral hydronephrosis. Patient referred to the emergency department for further evaluation.

A 4-year-old boy was bitten on the right index finger by a goat at a petting zoo. The bite created 2 superficial 2-mm open wounds. One of the lesions developed into an indurated 8-mm nodule during the following week. A second nodule developed about 5 days later. The boy was seen by his physician 2 weeks after the bite wounds occurred. At that time, an 8-mm umbilicated nodule and a satellite papule were present.

A 9-year-old Hispanic boy, previously in good health, was admitted for evaluation of chronic right cervical adenopathy. The node had been present for about 6 weeks. The patient was initially taken to his primary medical doctor and given dicloxacillin, but there was no improvement. The patient reported no fever, sore throat, travel history, or animal exposure. He and his parents denied contact with any persons with tuberculosis. During the past year, the patient had undergone extensive dental work for excessive caries.

A 4-year-old girl presents with a highly pruritic rash. The day before, she had been playing outdoors at her grandmother's house. No pets were present, and the patient does not recall being stung or bitten by insects. There are bushes on the grandmother's property.

A 6-month-old infant was brought to the emergency department with a 2-day history of increasing redness and swelling of the cheek. Her primary care physician had been concerned about a possible facial abscess.