Dermatology

A 28-year-old man presents with pruritic, well-demarcated, erythematous plaques with silvery scale over extensor elbows and knees and scalp. Nail pitting is present.

A 67-year-old man with a slowly enlarging pearly papule with telangiectasias on the nose; central ulceration and rolled border.

A 52-year-old woman with chronic sun exposure has a rough, scaly, erythematous papule on dorsal hand that feels like sandpaper; tender on palpation.

A 34-year-old woman develops intensely pruritic vesicles on elbows and knees; she has celiac-type GI symptoms. Direct immunofluorescence shows granular IgA at dermal papillae.

A 72-year-old with a history of chronic sun damage presents with a nonhealing ulcerated, indurated nodule on lower lip; tender, scaly surface.

A 19-year-old has comedones, inflammatory papules, and nodules on face and back; scarring present.

A 30-year-old woman with symmetric hyperpigmented macules on cheeks, worse after sun; uses OCPs.

A 55-year-old man with new, intensely pruritic, tense bullae on trunk and flexures; negative Nikolsky sign; biopsy shows subepidermal blisters with linear IgG/C3 along BMZ.

A 42-year-old woman with annular, scaly plaques with central clearing on the thigh after gym; KOH prep shows hyphae.

A 6-month-old with erythematous plaques with oozing/crusting on cheeks and extensor limbs; strong family history of atopy.

A 7-year-old boy has honey-colored crusted lesions around nose and mouth after scratching eczema.

A 25-year-old woman has a single “herald patch” followed days later by multiple oval salmon-colored plaques with fine collarette scale along cleavage lines on trunk; mild pruritus.

A 31-year-old man develops sudden widespread targetoid lesions on trunk and extremities after HSV outbreak; mucosal involvement minimal.

A 68-year-old nursing home resident has an erythematous, sharply demarcated, macerated plaque with satellite pustules in intertriginous groin folds.

A 44-year-old woman with photosensitivity develops well-demarcated depigmented patches on hands and perioral skin; hair in areas is white.

A 63-year-old smoker with COPD develops violaceous, polygonal, flat-topped papules on wrists and oral lacy white plaques (Wickham striae).

A 29-year-old hiker returns with intensely pruritic linear vesicles on forearms after clearing brush.

A 75-year-old man with chronic leg edema has pruritic erythema, hyperpigmentation, and medial ankle scaling with lipodermatosclerosis; shallow weeping ulcer above medial malleolus.

A 38-year-old woman with painful nodules on shins; recent sore throat; CXR shows hilar fullness.

A 58-year-old woman with blistering photosensitivity, skin fragility on dorsum of hands, hypertrichosis of face; LFTs mildly elevated; urine fluoresces pink under Wood lamp.

A 50-year-old obese woman with recurrent painful nodules and abscesses in axillae and groin with sinus tracts and scarring.

A 36-year-old woman develops fever, facial edema, and diffuse morbilliform rash 3 weeks after starting carbamazepine; eosinophilia, elevated ALT; lymphadenopathy.

A 41-year-old man with new, rapidly enlarging “stuck-on,” waxy, warty lesions over trunk with pruritus; he also lost weight recently.

A 62-year-old farmer has a chronic nonhealing ulcer at a burn scar site; rolled edges and exophytic granulation tissue.

A 26-year-old man with fever and sore throat starts amoxicillin; 24 hours later he develops diffuse, pruritic morbilliform rash; EBV IgM positive.

A 70-year-old woman has a 1-cm, firm, hyperkeratotic dome-shaped nodule with central keratin plug on forearm that grew rapidly over 6 weeks.

A 17-year-old swimmer has painful paronychia and green discoloration under nail after frequent pool exposure.

A 45-year-old woman has facial flushing, persistent central facial erythema with telangiectasias, and papulopustules; ocular irritation present.

A 9-year-old boy with patchy hair loss and black dots on scalp; posterior cervical LAD; KOH positive.

A 33-year-old woman with well-circumscribed round patch of complete hair loss; exclamation point hairs at margin; nails show pitting.

A 60-year-old woman presents with recurrent angioedema of lips and wheals lasting <24 h each; triggers include NSAIDs and pressure; no airway compromise today.

A 35-year-old man with poorly controlled diabetes has a fluctuant, tender nodule with central pustule on thigh; multiple lesions recur.

A 48-year-old fisherman develops bright red, sharply demarcated facial erythema with edema and pain; fever; rapid onset.

A 58-year-old man develops flaccid bullae and erosions on skin and oral mucosa; positive Nikolsky sign; biopsy: intraepidermal acantholysis; DIF: intercellular IgG in “fishnet” pattern.

A 23-year-old runner has small, painful vesicles on lateral fingers with pruritus; worsens in warm weather; hands sweaty.

A 75-year-old bedridden man develops a sacral ulcer exposing subcutaneous fat but not fascia or bone.

A 40-year-old woman presents with painful, rapidly enlarging ulcer on the leg with undermined violaceous border; history of ulcer worsening after debridement; IBD present.

A 66-year-old man develops dozens of small, yellow papules on extensor elbows and buttocks during a hypertriglyceridemia flare (TG 1800 mg/dL).

A 59-year-old man on allopurinol develops fever, malaise, diffuse painful dusky rash with mucosal erosions involving 20% BSA; Nikolsky positive.

A 64-year-old woman presents with gritty foreign body sensation and photophobia; slit-lamp shows dendritic corneal ulcers; concurrent grouped vesicles on eyelid.

A 46-year-old man has thickened, yellow, dystrophic great toenails with subungual debris and onycholysis. KOH from nail scraping is positive for hyphae.

A 22-year-old woman has multiple hypopigmented and hyperpigmented macules with fine scale on upper back; KOH shows short hyphae and spores (“spaghetti and meatballs”).

A 28-year-old man with severe nighttime pruritus has excoriated papules and burrows in finger webs, wrists, and waistband; family members itchy.

A 7-year-old girl with scalp pruritus has numerous nits attached to hair shafts within 1–2 mm of scalp and live lice seen.

A 26-year-old man has clustered, dome-shaped, umbilicated pearly papules on genital area; HIV test negative.

A 14-year-old boy has rough hyperkeratotic papules on dorsal fingers with thrombosed capillary dots.

A 32-year-old runner has painful plantar lesion; paring reveals pinpoint black dots and interruption of skin lines; pain with side-to-side squeeze.

A 29-year-old woman develops perioral papulopustules sparing the vermilion border after weeks of using potent topical steroids for “rash.”

A 38-year-old man with scalp and brow flaking has erythematous patches with greasy scale on scalp, nasolabial folds, and chest.

A 35-year-old woman has painful erythematous plaques in axillae and inframammary folds without scale; biopsy shows psoriasiform changes.

A 21-year-old develops sudden eruption of dozens of 2–6 mm “drop-like” scaly papules on trunk/limbs 2 weeks after streptococcal pharyngitis.

A 46-year-old woman abruptly develops generalized erythema with sterile pustules, fever, and malaise; labs: leukocytosis; triggers include steroid withdrawal.

A 40-year-old woman develops photodistributed annular scaly plaques on shoulders and forearms; anti-Ro/SSA positive; minimal systemic symptoms.

A 58-year-old man develops palpable purpura on bilateral lower legs 1 week after starting a new antibiotic; biopsy shows leukocytoclastic vasculitis.

A 7-year-old boy has palpable purpura on buttocks/legs, abdominal pain, arthralgia, and hematuria after URI.

A 30-year-old woman develops a solitary violaceous plaque on the lip each time she takes naproxen; leaves postinflammatory hyperpigmentation at same site.

A 42-year-old man has annular erythematous plaque with indistinct borders on thigh after months of potent topical steroid use for “ringworm.” KOH positive for hyphae.

A 36-year-old woman with diabetes has well-demarcated, atrophic, shiny yellow-brown plaques with telangiectasias on anterior shins; occasionally ulcerates.

A 64-year-old woman with severe vulvar pruritus has porcelain-white atrophic plaques with fissures and architectural loss of labia minora.

A 35-year-old man with untreated HIV presents with violaceous papules and plaques on legs and palate; biopsy shows spindle cells with vascular slits; HHV-8 positive.