Clinical Quiz

Clinical Challenge: Rash around the mouth for one year

A 13-year-old boy presents with a chief complaint of a rash around his mouth, which has been present for approximately one year. There is occasionally a slight itching or burning associated with the rash. The patient’s parents state that the boy is humiliated by his appearance and does not want to go to school because…

Flat-topped, slightly violaceous papules

A 50-year-old otherwise healthy black male presents complaining of itchy papules that have been present for several months. He denies any preceding illnesses or medication changes. Besides extreme pruritis, his review of symptoms is negative. Past medical history is unremarkable. Family history is noncontributory. He was seen recently at an urgent care clinic and prescribed…

Clinical Challenge: Itchy pink patches

A 38-year-old man presents complaining of itchy red patches on his back that have been present for months. His primary medical doctor initially prescribed clotrimazole antifungal cream for tinea corporis. When the lesions did not improve, the patient was given triamcinolone topical corticosteroid cream to treat a presumed eczema. The triamcinolone relieved the itchy sensation,…

Clinical Challenge: Papules on the penis

A 24-year-old man presents complaining of “bumps” located on the shaft of his penis. He is not sure how long the bumps have been present and denies itch or other discomfort. The patient is otherwise healthy and not taking any medications. He is sexually active with women and has had two partners in the past…

Clinical Challenge: Scaly Patches After a Throat Infection

A 6-year-old Hispanic girl was brought by her mother to the dermatology clinic with a two-week history of a scaly rash. According to the mother, the child had a throat infection two weeks prior to developing the rash. The rash was mildly pruritic, but the girl was otherwise asymptomatic. Physical examination revealed the presence of…

Clinical Challenge: Facial Edema, Fevers, and Rash

A 30-year-old Hispanic woman presents to the ED after 10 days of malaise, fevers, and pharyngitis, and seven days of rash. One day prior, the patient’s primary care doctor diagnosed her with scarlet fever and prescribed penicillin, but the rash continued to worsen.The patient states that the rash began on her face and abdomen, and…

Clinical Challenge: Fever and Rash for Eight Days

A 2-year-old black female presents to the ED with her mother after experiencing eight days of high-grade fever (up to 103° F) and six days of rash. The mother states that the rash began on the patient’s hands and feet and subsequently became generalized. On day three of illness, the patient developed erythema in her…

Figure 1

Clinical Challenge: A Rash Response to Southern Exposure

A 28-year-old Hispanic man presented with a 10-month history of a pruritic rash on his right flank (Fig 1). One to two weeks prior to noticing the lesion, he had spent five days in Arizona. The lesion had doubled in size in one month, according to the patient. He had no history of similar rashes…

Clinical Challenge: Anogenital ulcerations in a female with HIV/AIDS

A 23-year-old female presents to the ED with a 6-month history of exquisitely painful genital ulcers. The patient reports that she initially developed a small white pustule that broke and then formed ulcers around her labia minora. She continued to have multiple ulcers around her genital region that would heal and reappear. During the past…

Clinical Challenge: Blisters, blotches and burning in a 42-year-old woman

A 42-year-old woman with herpes simplex virus (HSV) 1 presented with a five-year history of monthly recurring oozing plaques and blisters on her face, hands and forearms.The eruption was preceded by a burning sensation, and the lesions always appeared at the same locations. A similar eruption had occurred 12 years earlier but abated after a…