Dermatology

This 20-month-old patient with eczema has had a flare during the past week.

I enjoyed Drs Olivera and Lasser's recent "Case In Point" involving an 18-year-old with varicella-zoster virus (VZV) meningitis1 and found the case and illustrations informative and interesting.

A 6-year-old boy has a rash on his hands and feet that erupted shortly after he startedfirst grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.

A 16 year old African American teenager complains of itchy bumps on the back of his neck for a 2-year period. What's the diagnosis?

Oral contraceptive (OC) pills are frequently prescribed for a variety of clinical purposes. These medications--which contain varying amounts of estrogen- and progestin-based compounds--essentially "override" a woman's innate hypothalamic-pituitary-ovarian axis and frequently help ameliorate the effects of a maturing reproductive system while preventing pregnancy.

This young girl is brought to your office with a rash that her mother thinks is triggered by sunlight. The mother is concerned because her own aunt has lupus erythematosus. The mother also reports that several children at her daughter's school have a similar eruption.

A 16-month-old Hispanic girl presented with a 2-day history of pain, redness, and swelling of the left side of her groin. Her mother first noticed the lesion after the child was seen limping and scratching the area. The mother thought her child had been bitten by an insect but did not witness any bite.

In the February 2007 issue (Photo Quiz, page 88), there is a case of a child with a rash diagnosed as erythema multiforme (EM) rather than urticaria. I assume that these were fixed lesions, which distinguished them from urticaria lesions? Also, if this rash had been caused by the antibiotic the patient had been taking for an acute otitis media infection, why did it first manifest after 4 days of treatment?

A well-nourished 17-year-old of average height and weight was referred for evaluation of persistent right lower leg pain of 3 months' duration. He was not taking any medications, had no allergies, and denied trauma to the area.

I read with interest the Dermclinic case on molluscum contagiosum in your February issue. I was a bit surprised by the last sentence, in which Dr Barber comments, "I often instruct affected young adults to pierce the top of the lesions and try to extrude the central core using lateral pressure with the rounded end of a popsicle stick or similar device . . ."

A 12-year-old girl was brought by her parents for evaluation of a spot in her eye, which they feared might be an embedded foreign body. She had nominal eye discomfort, which was probably secondary to attempted removal of the object. The child could not recall having dust particles in the eye, and she had no previous eye lesion.

The pearly papules on the cheeks (A), ear, and scalp (B) of 2 newborns are classic presentations of milia. The white or yellow papules range from 1 to 2 mm in diameter. They result from retained keratin and sebaceous material in pilosebaceous skin. The lesions commonly affect the face and may be present at birth or develop within the first few days of life.

This 17-year-old presented with multiple boils in the perineum and under breast and skin folds. The lesions produced a malodorous discharge (which caused problems with peer acceptance at school) and were increasing in size. Oral antibiotics had not helped. The patient was admitted for intravenous antibiotic therapy.

It is early evening when a previously healthy 2-year-old Hispanic girl is brought to the hospital by her mother. The girl has a history of fever to 100.2 F axillary, and skin lesions that began four days earlier. The skin lesions are described as following a progressive course. The lesions would begin as non-itchy red patches with a central vesicle that would burst, leaving an ulcer with a black base.

ABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among females of reproductive age. In adolescents, PCOS often manifests with irregular menses, hirsutism, and acne. Despite general agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents. Treatment is focused on weight loss, menstrual cycle regulation, and amelioration of physical symptoms. Acute symptoms can be managed with combination oral contraceptives and antiandrogens and potentially with insulin-sensitizing drugs. Lifestyle modification, especially in overweight patients, can reduce symptoms and help prevent long-term health consequences.

A scaly, erysipeloid rash had erupted in the axillae of an 8-year-old boy and spread to the buttocks and thighs within 2 days. The child complained only of pruritus. The rash had worsened despite treatment with clindamycin for 4 days.

The mother of this 5-week-old girl reports that her baby's head tilts to the right. The mother was a primigravida; unremarkable pregnancy.

This rash has developed over the past few months in a 4-month-old girl. The infant does not seem to be bothered by it. Her mother thinks that the rash started a few days after a family picnic.

A 13-year-old girl noticed that the skin around a "mole" on her abdomen had gradually changed color. This patient was told that she had a halo nevus--a pigmented (nevocellular) nevus surrounded by a tight ring of depigmentation--which is benign and usually regresses spontaneously over time. This relatively common lesion is believed to affect males and females equally. The development of the halo may coincide with puberty or pregnancy. Often, several pigmented nevi develop a halo simultaneously.

A 4-year-old girl was brought to a local emergency department (ED) after an episode of dizziness, vomiting, and horizontal nystagmus.

A 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies.

A 10-year-old boy had a 3-day history of an itchy eye. His mother thought he had somehow cut his upper left eyelid.

The rash on the upper torso, arms, and back of an 11-year-old started after he had a headache and fever for 3 days. The patient also has a distinctive pharyngitis with redness and some petechiae.

A teenaged boy presented with this large, light brown pigmented macule that developed after he returned from a vacation with his family in Florida. He takes no medications and has been healthy.

Sixteen-year-old boy referred to pediatric emergency department (ED) by his primary care physician with a history of headache, blurred vision, and mild proptosis of right eye. Vision: 20/200 OD (right eye) and 20/25 OS (left eye).

A University of Auckland study concluded that young people seeking treatment for acne should be screened for depression.

Two examples of polydactyly are shown. Photos A and B show a female newborn's right hand with an almost fully developed extra thumb; the radiograph shows what appears to be the distal phalanx bone of the extra digit.

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.