Robert P. Blereau, MD

September 14, 2005

Hyperpigmentation involving the neck developed in this 8-year-old obese girl. The affected area resembled unwashed skin. The patient had worn a uniform to school-a jumper and blouse with a collar-for 6 months.

September 14, 2005

A mother, fearing that her 4-year-old son had been abused at his day-care center, rushed him to the emergency department, where an evaluation revealed a platelet count of 1,000/µL. Except for bruises on the boy's face and legs, the physical findings were normal. Bone marrow aspiration showed numerous megakaryocytes and was otherwise normal. The youngster's history included treatment for bronchitis, sinusitis, and conjunctivitis 2 weeks earlier.

September 14, 2005

An afebrile 23-year-old man with no cervical gland enlargement presented with the very painful, large, shallow, yellowish-based ulcer shown here.

September 14, 2005

Erythematous, scaly lesions with double-edged borders had been present on a 14-year-old boy's left upper arm and lower legs for about a year. The lesions were occasionally pruritic, and some resembled ringworm. At times, fine yellow crusting suggestive of impetigo was present. The boy took very hot baths and showers.

September 14, 2005

For 2 years, a 40-year-old oil-field worker wore heavy, steel-toed work boots all day. He experienced weeping and white discoloration at the center of both distal soles. At night, with his boots off, the feet would dry and hurt. There was no pruritus.

September 14, 2005

Two 7-year-olds show the purpuric rash of the lower body and legs that is typical of Henoch-Schönlein purpura. This disease is a vasculitis that chiefly affects small vessels of the skin, joints, gastrointestinal tract, and kidney.

September 14, 2005

A 3-mm long, double-tipped, polypoid lesion appeared just anterior to the anus on an 8-month-old girl 2 days earlier. The lesion was excised in the office: a local anesthetic was administered, and the base was lightly electrodesiccated. Antibiotic ointment was applied until the area healed. Pathologic findings identified an infantile perianal pyramidal protrusion.

September 14, 2005

During a routine preschool examination, it was noted that this 4-year-old boy, who weighed 30.8 kg (68 lb), did not seem to rotate his arms. The child's mother stated that she first noticed this 2 or 3 years earlier but thought it was related to her son's obesity. The youngster appears to function normally; he is able to write and play football and basketball. No other family members are known to be similarly affected.

September 14, 2005

The entire scalp of this 1-month-old boy shows the diffuse yellow scaling of seborrheic dermatitis. Called “cradle cap” in infants, this dermatitis typically begins on the scalp during the first 3 months and may spread over the entire face. An associated stubborn diaper rash may develop in some infants.

September 14, 2005

A 56-year-old woman was bothered by “something protruding” from her vagina. She had no pain, bleeding, or dyspareunia.