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.
