58yo female with hyperpigmented papules on arms and palms

Presenter: Olga Demidova, DO; Laura Jordan, DO; Cole Cahill, DO; Schield Wikas, DO; Monte Fox, DO
Dermatology Program: Tri-County Dermatology
Program Director: Schield Wikas, DO
Submitted on: Nov 5, 2016

CHIEF COMPLAINT:  A 58-year-old female presented to the dermatology clinic with complaints of asymptomatic hyperpigmented papules over arms and palms.

CLINICAL HISTORY:

Signs and symptoms:  A 58-year-old female was referred to the dermatology clinic by her primary care physician for evaluation of asymptomatic hyperpigmented papules involving her arms and palms. Growths appeared several weeks prior to the initial visit. During the visit, the patient reported mild shortness of breath that is chronic for her and may have worsened in the past few weeks. She denied changes in medications and any recent illness.

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Worsening rash in female with history of cord blood transplant

Presenter: John Howard, DO PGY-2
Dermatology Program: Larkin Community Hospital/NSU-COM, South Miami, FL
Program Director: Stanley Skopit, DO, MSE, FAOCD, FAAD
Submitted on: Oct 26, 2016

CHIEF COMPLAINT:  A 12 year old African American female with history of immunodeficiency syndrome due to a NF-kappa-B essential modulator (NEMO) gene mutation, currently status post umbilical CBT before age 1 with myeloablation-induced hypothyroidism and hypoestrogenism, presented to Advanced Dermatology & Cosmetic Surgery in Margate, Florida as an outpatient complaining of a progressively worsening pruritic rash on her extremities and trunk for several months.
The patient denies preceding or current upper respiratory infection, cough, sore throat, fever, chills, arthralgias or diarrhea. She presents with recent negative bloodwork for South Florida environment allergy panel and negative T.R.U.E. allergy patch testing. Her only medications are levothyroxine 62.5mcg daily and estradiol 0.025 mg/hr weekly patch for Hashimoto thyroiditis-induced hypothyroidism and hypoestrogenism respectively. She has no known drug allergies.
Family history is significant for an older brother who unfortunately passed away shortly after birth due to a NEMO mutation and the mother states she is the carrier.

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Persistent nipple dermatitis

Presenter: Shannon McKeen, DO, PGY4
Dermatology Program: MSUCOM/Lakeland Regional Medical Center
Program Director: Mark A. Kuriata, DO, FAOCD
Submitted on: Oct 22, 2016

CHIEF COMPLAINT:  63-year-old Caucasian female with a persistent rash on the right breast.

CLINICAL HISTORY:

Signs and symptoms:  In February of 2000, the patient underwent excision of a ductal carcinoma in situ, high nuclear grade with focal microinvasion of the right breast. This was followed by eight weeks of radiation therapy and a five year course of tamoxifen. She did not seek follow up imaging until 2004, which had showed calcifications. Biopsy of the calcifications showed recurrent ductal carcinoma in situ. At that time, the surgeon recommended mastectomy with axillary lymph node dissection. The patient refused due to concerns over loss of function and swelling in the arm. In 2016, several months prior to her presentation in our office, the patient developed a rash on the right breast. The rash involved the areola and periareolar skin. The patient described the rash as red, itchy and mild in severity. She was seen by her Gynecologist who gave her a topical corticosteroid cream, which helped improve the rash somewhat, only to return upon discontinuation. The patient also reported using a “diaper rash cream” which mildly improved her symptoms. The Gynecologist ordered a 3D mammography and subsequent ultrasound. Both reports were read as having dystrophic calcifications, recommending six month follow up exams. The patient was referred to our office for her persistent rash. At initial consultation, we ordered an MRI of the right breast, referred her to the general surgeon who performed the initial excision in 2000 and the patient was given samples of flurandrenolide 0.05% cream to apply twice daily until follow up. The patient called several days later and refused MRI, as well as cancelled the appointment with the general surgeon. She was instructed to return to the office for a biopsy.

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15 year old with hair loss since 3 months of age

Presenter: Kevin Svancara, DO, Jonathan Bellew, DO
Dermatology Program: Advanced Desert Dermatology (MWU)
Program Director: Vernon T. Mackey DO
Submitted on: Aug 24, 2016

CHIEF COMPLAINT:  Hair loss and thinning of the scalp

CLINICAL HISTORY:

Signs and symptoms:  15 year old female presents with diffuse hair loss and thinning of the scalp. Her hair loss is worse on the posterior scalp. She states her scalp is flaking, itching, and burning. Her symptoms have been present since she was three months old. She states her hair breaks very easily. She also reports small rough bumps on the backs of her arms and lateral legs that occasionally itch.

PMH: Bipolar Disorder
Medications: Depakote, Ketoconazole 2%shampoo
Family History: No significant family history. No family history of similar hair condition. Does not know her father or his family history
Social History: Student, non-smoker, no alcohol
Surgical History: None
Allergies: NKDA
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Pruritic, tender lesions on lower legs

Presenter: Vukmer DO PGY3, Tyler O. Petrosian OMGE 4, Serge
Dermatology Program: Hackensack at Palisades UMC
Program Director: Ros DO FAOCD, Adriana
Submitted on: Jul 30, 2016

CHIEF COMPLAINT:  A 68 year-old hispanic male presented complaining of a 2 year history of very pruritic, tender lesions on his lower legs.

CLINICAL HISTORY:

Signs and symptoms:  The patient also complained of a years long history of arthralgia and asthma.

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