Macrodistribution

Dorsum of hands, fingers, periungual tissue, and knees in children (see Fig. 4 Photos 11,12). 2. Beard area and neck in young adult men (see Fig. 5 Photo 13). 3. Periungual warts are usually associated with nailbiting. This habit must be controlled for successful treatment of the warts. Figure 4 Macrodistribution of verrucous warts in children. Figure 4 Macrodistribution of verrucous warts in children. 4. Common warts may occur at virtually any site on the skin or mucous membranes. Indicated...

Specific History

Pityriasis rosea (PR) is a common dermatitis that acts like a viral exanthem. Peak incidence is during the second and third decades, although it can occur at any age. Onset is acute and usually consists of the sudden appearance of a single skin lesion, referred to as the herald plaque or patch. About 5 of cases have a prodrome with mild constitutional symptoms, sore throat, GI complaints, and or cervical adenopathy. In a significant number of patients, the initial lesions are overlooked or...

Dermatologic Physical Exam

Plaques of pigmented skin lesions are generally palpably raised above the adjacent normal skin. Color may vary from light brown to brown-black. Dark brown is usual. The surface may be smooth, mammillated, lobulated, or thrown into deep folds (rugose). Areas of speckling are common, especially with small CMN, medium CMN, and the acquired type. Margins are usually distinct. Sizes of CMN were discussed earlier. AcpN tend to be between 0.4 and 1.2 cm in size (see Photos 21-24). Hypertrichosis in...

Therapy

The treatment of acne involves skillful use of medications, avoidance of provoking factors, physical evacuation of cysts and comedones, and in some cases intense emotional support. Therapy must be tailored to each case and must be adjusted regularly as condi- Figure 4 Macrodistribution of acne vulgaris. Figure 4 Macrodistribution of acne vulgaris. tions change. In general, grade I and mild grade II acne can be treated with topical regimens. Moderate to severe grade II and grade III disease...

Clinical Application Questions

A 50-year-old male diabetic presents with an extensive eruption on the lower back and buttock areas. He complains of intermittent pruritus and occasional tender deep pimplelike lesions. 1. List the disorders that you should consider in the differential diagnosis of this patient's eruption. 2. How would you distinguish tinea corporis from the other disorders in your differential diagnosis 3. Where else on this patient's body is fungal infection likely to be found 4. If a diagnosis of fungal...

Conditions That May Simulate Herpes Simplex Recidivans

Both diseases are common in the central facial region, and both begin with small clear vesicles on an inflammatory base. Herpetic lesions tend to remain fixed and discrete, and the vesicles are small, 1 to 2 mm across, tightly grouped, and persist for longer periods. Facial HSV occasionally develops secondary impetigo, causing some diagnostic confusion. A smear with a Gram stain will often show bacteria with cases of impetigo. A Tzanck smear of a blister base will show herpes virus cytopathic...

Application Guidelines Systemic Lupus Erythematosus

If a malar rash is present at onset, it usually appears abruptly. Photosensitivity can be present but is not as prominent a feature in SLE as in cutaneous lupus erythematosus. Although skin lesions occur in 80 of SLE patients during the course of their disease, they are a presenting sign in only about 13 . Joint and other visceral symptoms predominate. Cutaneous lesions are nevertheless important because they constitute four of the 11 criteria used by the American Rheumatism Association to...

How is history helpful in the diagnosis

Answer In addition to information regarding sexual activity and cyclical recurrences, specific questions establish the following facts a. Onset is heralded by an aura of itching and burning 12 hours before a visible lesion. b. Lesions have recurred at approximately the same site each time. c. The patient clearly describes an evolution from a red welt to bumps, blisters, and crusts. d. Evolution of each episode is about 10 days from start to finish. e. Lesions are described as irritable and...

Conditions That May Simulate Acne Vulgaris

Papulopustular rosacea may resemble acne, but usually occurs on a backdrop of flushing and telangectasia. Comedones and cysts are absent except in rare cases when both diseases occur simultaneously. Most rosacea lesions are on the face. This localized eruption is almost exclusively limited to female patients. It presents with a localized papular and eczematous eruption with tiny pinpoint pustules in the perioral, perinasal, or periocular areas of the face. It superficially resembles acne, but...

Molluscum Contagiosum Dimple Warts

Medical Dermatology Human Figure

A 16-year-old male high school student presents with a large number of papular lesions of recent onset in the right thoracic and axillary region. There is a second grouping of similar lesions on the right knee. The patient is on the wrestling team, desires removal of the lesions, and was sent to you by his wrestling coach to find out if they might be contagious. You suspect this is molluscum contagiosum. 1. What are the primary lesions you would expect to find in molluscum contagiosum 2. What...