Practice Management
A 63-year-old woman visits urgent care with the chief complaint of an asymptomatic scabby growth on her scalp that developed 10 months prior and is gradually getting larger. The patient has no systemic symptoms and is otherwise well. She has a history of working as a welder in a metal fabrication plant for the past 35 years. On dermatological examination, an eroded and crusted plaque is seen on the frontal scalp. A punch biopsy reveals …
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A 39-year-old male presents to the local urgent care reporting an intensely itchy rash for the past 3 weeks that is getting gradually worse. The patient has a history of HIV infection, denies any recent travel or trauma, and is not taking any medications. Physical exam shows he is afebrile with normal vital signs. He has diffuse papular lesions to the trunk and arms ranging from pink to dark brown in color, some with notable …
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A 67-year-old man visits urgent care for a lesion on his right ankle that was first noticed 25 years ago. He reports that it has progressively grown larger over the past 6 months. The lesion is painless but is intermittently mildly pruritic. The patient denies any recent injury or past medical history besides chronic venous insufficiency. On dermatologic examination, a discrete dark brown plaque is noted posterior to the lateral malleolus with numerous surrounding spider …
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A 53-year-old male butcher visits urgent care for a painful red rash that developed on his hand 3 days prior. There is no history of recent travel, but he accidentally cut himself when processing meat 1 week ago. Exam reveals that the patient is febrile at 100.2° F. Otherwise, his vital signs are within normal limits, and he is well appearing. On dermatologic examination, erythematous vesiculated papules, plaques, and associated edema are visible on the …
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A 75-year-old male presents to the walk-in clinic with the chief complaint of an asymptomatic rash on the left temple of his face that developed over the past 2 months. On examination, a shiny deep red papule is visible with scaly macules (actinic keratoses) surrounding. The patient is on rituximab for chronic lymphocytic leukemia (CLL). View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described …
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A 36-year-old man presents to urgent care with asymptomatic hair loss that developed on multiple sites of his scalp over the previous 2 months. The hair loss developed in round patches that expanded to involve most of the back of his scalp. His past medical history is notable for hyperthyroidism. View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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A 45-year-old woman presents to urgent care with a painful area that developed on her right ankle 2 weeks prior. The patient had a family history of venous thromboembolism. On examination, a variegated brown patch with a central pink angulated scar and an overlying thick crust on the lateral ankle was seen. There was also unilateral peripheral leg edema. On laboratory examination, anemia, thrombocytopenia and anticardiolipin antibodies were present. View the image and consider what …
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An 18-year-old man presented to urgent care with fever, pain in multiple joints, and a back rash that had been progressive for the last few weeks. On examination of the back, there were multiple painful erythematous and violaceous papules and nodules as well as several large pustules. Some of the lesions were eroded and crusted. The patient reported that he recently started an intensive bodybuilding regimen with a 3 month use of anabolic-androgenic steroid/testosterone prior …
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A woman brings her 7-year-old son to the urgent care center with a rash that had developed “over the past few weeks.” On examination, there are smooth, pink papules around the mouth. The mother reports that the patient has a history of asthma, for which he uses inhalation budesonide daily as maintenance therapy. Otherwise he is healthy, has no systemic symptoms, and is well-appearing. View the photo taken and consider what your diagnosis and next …
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A 43-year-old woman presents with 2 weeks of a smooth nodule on her right hand. The patient denies recent travel but recalls that she “banged up” her hand while cleaning out a fresh-water fish tank prior to noticing the nodule. Past medical history is significant for renal transplantation. Exam reveals a tender, erythematous plaque with an ulcer on dorsal aspect of her hand. View the image and consider what your diagnosis and next steps …
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