Charles E. Crutchfield III, MD

September 14, 2005

An otherwise healthy 34-year-old woman was concerned because of the abrupt onset of rapid hair loss, accompanied by scaling of the underlying skin. The disorder had begun 3 months earlier, and the right parietal and temporal areas were now red and swollen and had adherent scale. An antinuclear antigen titer was negative. Biopsy revealed changes consistent with lichen planus of the scalp, also known as lichen planopilaris and lichen planus follicularis.

September 14, 2005

A mildly itchy, tender “red bump” on his eyelid concerned a 68-year-old man. Two years earlier, a basal cell carcinoma, which started as a “red bump,” had been removed from his cheek. This lesion had been present for 2 weeks; the patient noted a small amount of discharge at the site in the mornings.

September 14, 2005

A 44-year-old woman was being seen regularly for skin manifestations of systemic lupus erythematosus (SLE). During a routine visit, blotchy erythema and hyperpigmentation were noted on the normally exposed areas of her neck and upper chest; the submental area was spared. Close examination revealed fine telangiectases and poorly marginated hyperpigmented and hypopigmented macules.

September 14, 2005

A 63-year-old farmer first noticed multiple rough bumps on his hands and feet at least 20 years before pointing them out to his physician. A diagnosis of arsenical keratoses was made after the patient reported that as a child he had worked on his family's potato farm, where a commonly used pesticide, “Paris Green,” was applied to the plants. The active ingredient in this pesticide was inorganic arsenic.

September 14, 2005

A 42-year-old woman was hospitalized with an increasingly painful, ulcerated swelling of the right lateral thigh. The patient reported that while cleaning out her attic, she suddenly experienced an excruciating burning sensation in her thigh. Immediately, she rubbed the area with ice, which provided partial relief. An ulcer developed 24 hours later and began to enlarge.

September 14, 2005

A 40-year-old farmer had been complaining for 3 weeks of a tender, red, itchy, scaling plaque with papulopustules on one knee. A potassium hydroxide examination of the scale revealed fungal hyphae.

September 14, 2005

A 40-year-old man presented with tiny, intensely pruritic vesicles on the knees, legs, buttocks, elbows, and scalp.

September 14, 2005

An ulcerating nodule on his left pre-auricular region worried a 64-year-old man.

September 14, 2005

A 32-year-old woman became concerned about the numerous bumps on her upper face, which had been increasing in number for many years. Examination revealed clusters of 2- to 3-mm lesions-mostly monomorphic, flesh-colored papules lateral to the eyebrows and on the central forehead, inferior-medial eyelids, and upper cheeks. Some of the papules had a slight pink or yellow-brown appearance, and poorly demarcated brown patches (melasma) were noted on the cheeks.

September 14, 2005

A scaling, red, fissured area between digits 4 and 5 on her right hand sent a 33-year-old woman to her physician. Diagnosis of interdigital Candida was confirmed by a potassium hydroxide evaluation of material from the site.