Medical Images
Bullous Tinea Pedis
A woman in her 70s presented with a skin eruption on the left dorsal foot that had developed spontaneously 2 weeks before. The rash initially appeared with pruritic papules that evolved to fluid-filled blisters and persisted despite self-treatment with topical hydrocortisone 1% cream and antibiotic ointment. Examination revealed an erythematous plaque with tense and denuded bullae (Figure 1). She received oral cephalexin for presumed bullous impetigo. Bacterial culture and herpes simplex virus and varicella zoster virus polymerase chain reaction (PCR) swab results were negative.Lichen Planopilaris
A 46-year-old woman presented with a 1-year history of gradual asymptomatic hair loss in the anterior hairline. Examination revealed perifollicular erythema and scaling along the frontal scalp, with scarring of follicular ostia and rare lone hairs (Figure).Groove Sign in Eosinophilic Fasciitis
A 62-year-old woman had development of firm, indurated plaques on her legs following vigorous massage therapy. Her legs had a peau d’orange texture and exhibited a groove sign bilaterally (Figure). Investigations revealed peripheral eosinophilia, an elevated erythrocyte sedimentation rate, and skin biopsy findings compatible with eosinophilic fasciitis (EF).Nail Lichen Planus
A 56-year-old woman presented with a 1-year history of altered nail growth and fragility, causing pain and cosmetic concern. Examination revealed onychodystrophy of multiple fingernails and toenails, with onycholysis, distal nail plate splitting, pterygium, longitudinal ridging, and subungual hyperkeratosis (Figure). She had a concomitant pruritic eruption on her chest and extremities and gingival ulceration. The scalp and vulva were uninvolved.Pruritic Skin Eruption in a Pregnant Woman
A 21-year-old gravida1para0 previously healthy pregnant woman at 37 weeks’ gestation had a pruritic skin eruption that initially involved the umbilicus and spread to affect much of the abdomen, lower back, and extremities. Her pregnancy was otherwise uncomplicated. Urticarial lesions with rare blisters were noted (Figure 1). Skin biopsy revealed spongiosis and mixed dermal inflammation with eosinophils, whereas direct immunofluorescence revealed linear deposition of C3 along the basement membrane zone (BMZ) (Figure 2).A 73-Year-Old With a Linear Rash
A 73-year-old man with a history of bilateral hip replacements developed a unilateral, asymptomatic skin eruption on his left buttock 3 months after a left hip revision. Over the ensuing 3 years, he noticed mild irritation with heat exposure. Hydrocortisone 1% cream provided no benefit. Skin examination revealed linear pink to brown papules with overlying scale, which did not involve his previous surgical scar site (Figure 1). The clinical differential diagnosis included linear lichen planus, lichen striatus, persistent postherpetic granulomatous skin eruption, or other linear skin entities.Chemical-Associated Vitiligo
An otherwise healthy man in his 40s presented with white macules and patches that appeared on his skin several years ago. Initially, he noticed asymptomatic white discoloration on the ventral aspect of wrists, with subsequent involvement of thehead and neck. He had no relevant medical, drug, or family history, except for thyroid dysfunction in his mother. He worked in a laundry facility, with frequent exposure to detergents. Examination revealed well-demarcated hypopigmented patches without erythema or scaling on the ventral forearms (Figure 1).Purple Fingers and Toes
A 34-year-old female patient presented with painful erythematous papules on both hands and feet. The lesions appeared in late December and were increasing in number by the time she was evaluated in early spring. She was at 19 weeks of pregnancy, with no other new symptoms or relevant medical or drug history. On dermatologic examination, multiple mildly tender violaceous papules were noted bilaterally on tips of acral surfaces (Figure 1). No ulceration or necrosis was observed.Yellow Nails
A 57-year-old man presented with a 1-year history of yellowish discoloration and increased brittleness affecting his fingernails and toenails, with spontaneous avulsion of left toenail. On review of systems, he reported a history of progressive shortness of breath, fatigue, and chronic cough of 2 years duration, with unintentional weight loss. He denied use of tobacco or other drugs. Dermatological examination revealed diffuse yellow discoloration of all fingernails and toenails (Figure 1). Nail clipping sent for Grocott-Gömöri silver (GMS) staining showed negative results for fungal hyphae, excluding onychomycosis.Acquired Beauty Mark?: New Black Macule on the Face
An otherwise healthy young female patient presented with a new asymptomatic black lesion on her left upper cutaneous lip that developed shortly after spending time in the garden. Clinical examination revealed a 4-mm well-circumscribed black circular macule without associated inflammation (Figure 1). Due to concern for an atypical melanocytic lesion, a punch biopsy was performed. Histopathologic examination disclosed full-thickness epidermal necrosis with an underlying band of neutrophilic inflammation with karyorrhexis (Figure 2).
