14 yo girl with history of acne presents with a new rash. S | Figure 1
cbjohnso
Family Medicine
14 yo girl with history of acne presents with a new rash.
States that it happened once before a few months ago and resolved without treatment. This recurrence began 4 days ago. It is largely asymptomatic, but she notes that sometimes it feels irritated when she opens her mouth wide.
No other rashes or lesions noted.
Looking carefully you can see that it spares the vermilion border.
I suspect this is perioral (perioralfacial) dermatitis and started her on topical erythromycin gel (her insurance won’t cover pimecrolimus).
I wanted to present this case especially because there are not many good resources available for skin conditions in people with darker skin.
Case Details
- Patient used beclomethasone, but stopped and went back to over the counter hydrocortisone because she stated the high dose steroid made the rash hurt. Regardless, she notes the rash is fading (at about 50% of prior) and she is feeling better. If she represents with blisters I will biopsy uninvolved skin of thigh for DIF and consider oral steroids.
Additional Cases
The patient is a 26-year-old female with no relevant medical history.
Two weeks ago, she experienced diarrhea for five days, which was treated at home with symptomatic medication and furazolidone.
She is now presenting with itching all over her body, more intense in the scalp area. She notes that the rash only appears if she scratches the affected area. What are your thoughts?
41yof G4P3A1 beauty therapist noted this itching skin rash progressive over the past 6 months. Hypertensive not adequately responsive to Captopril changed to Enalapril and HClThiazide.. but that was long ago. She reports other community members with similar rash.
20yoF with no significant medical history presented to the ED with 1 week of intermittent abdominal pain, nausea, vomiting, and a non-pruritic rash on her legs. She also noted intermittent joint pain and swelling. She was seen originally at an urgent care center and treated empirically for Lyme disease without improvement in her symptoms. On further questioning, she revealed that she had a "head cold" about three weeks ago.
On exam, vitals are within normal limits. Lungs clear. Heart sounds normal. Abdomen diffusely tender but is soft. Skin exam as pictured. The rash is scattered, raised, non-blanching, and purpuric - found on her legs.
Labs show trace hematuria and a slight elevation in her creatinine.
What is the likely diagnosis? How would you manage it? Does this patient need to be admitted?
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?