Ted Rosen, MD

May 23, 2013

This is a classic keratoderma, which can be due to a variety of congenital defects in keratinization or acquired in association with disease states. Retinoids, systemic and topical, are the treatments of choice.

May 16, 2013

This solitary, very pruritic, annular lesion suggests dermatophytosis. KOH preparation verified the presence of Tinea faciei. This infection is usually associated with contact with a new kitten or puppy.

May 15, 2013

This clustered grouping of small, shallow erosions surmounting a slightly indurated plaque is characteristic for “cold sores.” Because no vesicles were present and the lesions appeared to be crusting over, the patient was advised to apply an OTC cream (docosanol 10%) per package insert instructions.

May 15, 2013

These small, pruritic papules appeared in the morning, which strongly suggests the bite of a nocturnal feeding arthropod. Insect bites arranged in clusters of 3 is typical for, but not diagnostic of, bedbug infestation.

May 13, 2013

This green discoloration is the result of subungual Pseudomonas aeruginosa colonization. Pathogenic bacteria can enter this space via many causes, including trauma or underlying lesions.

May 11, 2013

Guttate psoriasis often appears in conjunction with an upper respiratory infection, particularly streptococcal tonsillitis, as it did in this patient. This phenomenon is more common in children.

May 09, 2013

These oval, dyschromic macules surrounded by a palpable scale-like border are pathognomonic of disseminated superficial actinic porokeratosis, a disorder seen usually in those who have had considerable lifelong exposure to sunlight.

May 08, 2013

Prominent, pigmented polyangular scales on the extensor surfaces of the arms, legs, and trunk suggested recessive X-linked ichthyosis. DNA analysis demonstrated an abnormal steroid sulfatase gene, which confirmed the diagnosis.

May 04, 2013

Eccentric darker pigmentation in this small asymptomatic lesion strongly suggests malignant melanoma. This patient had a history of non-melanoma skin cancer, but was unaware of the questionable growth.

May 02, 2013

This is a classic keloidal mass, which can occur in any ethic group. Because keloids can be intensely painful, they almost always require removal.