48 yo woman presents for evaluation for suspected lower extr | Figure 1

cbjohnso

Family Medicine

48 yo woman presents for evaluation for suspected lower extremity cellulitis. Incidentally I notice these lesions on the extensor surface of her forearms. She says no clinician has ever asked her about them before. They get darker in the sun. She has had them as long as she can remember (since at least early childhood). Never received a diagnosis. They do not bother her at all. The symmetry and distribution are so distinctive, but it has me stumped. (I even cracked open a dermatology text but didn't find a good match.) Any idea what this might be? Thanks!

This is a 29 year old female I saw after she developed spontaneous erythema of her great toe-not to this extent. I treated her for paronychia. Since I saw her she has seen multiple providers and has been on multiple antibiotics, topical antifungals, topical and oral steroids and had the toenail removed. She has consulted with podiatry and dermatology. Dermatology sent her back to family practice and I am unsure what to do next. This is painful, has been present for 10 months and is worse. Neither podiatry or derm think it is fungal. Steroids didn’t change it. PMH: lichen planus, Raynauds, fibromyalgia and acne. Meds: cymbalta, aldactone and naproxen. She is not diabetic. She wears nail polish daily for the past 10 years. Next step?

Female patient, 65 years old, says that she was diagnosed with age spots by her derm. She has them for many years, she uses prescription cream without improvement. Is this correct diagnosis?

Patient stated that she shaves her arms but not near this area of the inside crease of elbow. Looks like shaving bumps but what does she do to make them go away? She is insecure about them.

I have a female patient who has these two lesions on her one leg. She has had them for +/- 1 year. No significant medical history. She is Asthmatic and she is not Diabetic. She says she scratches the lesions and they open up and bleed.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?