International Teledermatology

What is your diagnosis?

2007-05-06T06:26:00.000-07:00

This infant had an irregular and bizarre shaped patch of cicatricial alopecia on the vertex. What is your diagnosis?

A reddish brown eruption

2005-10-28T19:23:00.000-07:00

This 3-month-old infant was born with a generalized mottled eruption
comprised of reddish brown maculopapules. The mother of the infant
reported that the eruption would turn bight red and edematous as the
child cried. There was no family history of atopic diatheses. What
would be the differential diagnosis?

How do we differentiate between dominantly inherited and recessively inherited dystrophic epidermolysis bullosa on clinical grounds?

2005-08-31T01:35:00.000-07:00

Dominantly inherited dystrophic epidermolysis bullosa.

Linear IgA dermatosis resistent to oral dapsone and steroids

2005-06-12T05:11:00.000-07:00

This 4-year-old boy presented with seven month history of developing a vesiculobullous eruption affecting the lower limbs, the buttocks, and the face. Physical examination revealed mutiple clear round vesicles, bullae and erosions on large erythematous back ground. Many of the bullae were arranged to depict string of beads and cluter of jewls signs. Oral mucosa was not involved. A tzank smear and gram stain were negative. Other tests are pending. How would you treat this patient if his condition fails to respond to oral dapsone and steroids?

Ayza Skin Research Center, Lalamusa, Pakistan View more images on Global Skin Atlas

Generalized lichen planus...what should be the treatment strategy?

2005-06-05T10:16:00.000-07:00

Oral Lichen planus. The patient had extensive areas of skin, mucosa and nails involved. An increasing number of generalized LP cases is being reported. I usually ask for anti HCV, but it turns out to be positive in only a few cases. What would be the preferred treatment option for such florid cases? View Images

What causes pitted keratolysis and how would you treat this condition?

2005-05-23T19:38:00.000-07:00

How would you manage a case of pitted keratolysis?

How do we manage a case of Sneddon Wilkinson disease resistant to dapsone?

2005-05-13T19:06:00.000-07:00

Subcorneal pustular dermatosis also known as Sneddon Wilkinson disease, was first described by Sneddon and Wikinson in 1956. It is rare, benign, chronic relapsing pustular eruption of unknown etiology. The condition which characteristically affects flexural aspects of trunk, has more commonly been reported in middle-aged and elderly women. A background history of paraproteinemia, multiple myeloma, pyoderma gangrenosum, inflammatory bowel disease, or rheumatoid arthritis may be present.

The primary lesions arise within a few hours as flaccid pustules on normal or very mildly erythematous skin. The pustules can be either isolated or grouped, and they tend to coalesce, forming annular, circinate, or serpiginous patterns. The eruption resolves, leaving mild hyperpigmentation, over which further waves of pustulation may arise. The condition is differentiated from acute generalized exanthematous pustulosis and pustular psoraisis by the absence of fever and systemic toxicity.

Most of the cases of subcorneal pustular dermatosis respond to dapsone and topical steroids. What are other treatment options for the cases resistant to the conventional therapy. View image in GSA View Dr.Amor's article in DOJ

Sneddon Wilkinson disease

How would you manage multiple epidermal cysts?

2005-05-12T08:41:00.000-07:00

Proliferation of epidermal cells within a circumscribed space of the dermis gives rise to epidermal or epidermoid cysts. Epidermoid cysts of the genitals are common in the general population and may appear as a mass in the breast, the vulva, the clitoris, the penis, the scrotum, or the perineum. This young man developed multiple epidermoid cysts on the scrotum over several years. What should be the line of management in this case?
Epidermal cysts

Role of ACD to compositae in the pathogenesis of CAD

2005-05-06T10:05:00.000-07:00

Allergic contact dermatitis to compositae affects many people working outdoors in the fields. What is its role in the pathogenesis of chronic actinic dermatitis?

Chronic actinic dermatitis

Differential diagnosis of a non healing ulcer

2005-05-06T09:55:00.000-07:00

What would be the differential diagnosis for a non healing ulcer present on the nose of a young boy for at least six months ?

A non healing ulcer on the nose

Levofloxacin to treat an acute gonococcal infection

2005-05-05T19:42:00.000-07:00

Let me share my eperience of treating acute gonorrhea with oral ciprofloxacin, ofloxacin and levofloxacin. I have found levofloxacin the most effective to treat an acute infection. What is your experience with oral drugs used to treat gonorrhea?

Intracellular diplococci

How do we treat an extensive case of lichen planus?

2005-04-30T20:10:00.000-07:00

This 40-year-old man presented with a generalized eruption of multiple flat topped purple papules and plaques. How will you treat this patient? View more images of lichen planus

Lichen planus

Erythema annulare centrifugum

2005-04-26T13:12:00.000-07:00

Erythema annulare centrifugum is the commonest of the annular erythemas.It may have a trailing scale just behind the expanding edge of a lesion.This patient had multiple lesions some of which joined up to form larger polycyclic shapes.The lesions generally resolve over a three week period.Cases can be associated with infections,drugs,underlying collagen diseases such as lupus erythematosus and rarely internal malignancy.
I do not see this condition very often.If they do not have fungus in the groin or on their feet I am usually stumped in finding the cause.Have others been more successful? View Images

Psoriasis nails

2005-04-23T21:49:00.000-07:00

Psoriasis of the nails can have a variety of presentations depending on which part of the nail apparatus the psoriatic process involves.If the nail matrix at the base of the nail is involved then you get pitting, occassionally furrows and often a crumbling nail plate.If the nail bed is involved then you get onycholysis or separation of the nail from the nail bed.People often misinterpret this as a fungal infection.Treatment of this condition is very limited.Topical steroid lotions rarely penetrate the posterior nail fold adequately to alter the process.Intralesional steroid injection is very painful.Methotrexate orally can be used for serious nail disease.
Do others have any other effective treatments? View Images

Tinea Facei

2005-04-22T22:51:00.000-07:00

This young lady had a month's history of an expanding scaly area on her cheek.She had used a topical steroid cream and a topical antifungal preparation without effect.Scrapings grew Trichophyton mentagrophytes.It was likely she had acquired it from her friend's guinea pig View Images

PLEVA

2005-04-22T22:29:00.000-07:00

I think this little girl had the inflammatory variant of Pityriasis lichenoides (PLEVA).The necrotic papules were suggestive.She was not ill.Chickenpox and an inflammatory reaction to molluscum contagiosum were also considered in the differential diagnosis.Lymphomatoid papulosis would not be so extensive.Her bloods were all normal.She responded to erythromycin after about a week's therapy.A viral exanthem would also be in the differential.She had a past history of Atopic eczema
View Images

Papular Mucinosis

2005-04-22T14:13:00.000-07:00

Papular mucinosis is a confusing subject. This lady has had these papular lesions on the nape of her neck for 5 years.She has no paraproteinaemia.Histopathology showed localised mucin deposition.She had no lesions elsewhere.This is presumably a localised form of lichen myxedematosus but it does not really fit the usual classification.Any comments? View Images

Urticarial Vasculitis

2005-04-20T20:15:00.000-07:00

I usually think of urticarial vasculitis as an urticarial rash that lasts longer than 24 hours and is associated with hemorrhage into the skin.The hemorrhage will often appear at the edge of the urticarial wheals particularly on the legs.The histopathology is usually a lymphocytic vasculitis.I cannot say I have seen this picture on the hands before.Was a biopsy done?
I usually think of urticarial vasculitis as an early presentation of lupus erythematosus and do blood studies for any evidence. View Images

Topical retinoids to treat syringomas

2005-04-09T04:42:00.000-07:00

Syringomas are benign tumors derived from the ductal portion of the eccrine unit. They appear as skin-colored or hyperpigmented papules, typically on the eyelids and cheeks of middle-aged women. Clinical variants of syringomas include solitary, eruptive, milia-like, lichen planus-like, and plaque-type. What is your experience with topical retinoids to treat syringomas? View images

PubMed search on Retinoids and Syringomas

2005-04-07T03:28:00.000-07:00

Multiple lesions on the face and scalp

How to treat Molluscum contagiosum?

2005-04-07T01:33:00.000-07:00

Molluscum contagiosum involving the face and scalp could be bothersome both for the parents and the affected children. How do you effectively treat this condition in your practice? View images

Hailey-Hailey Disease Inframammary

2005-04-04T04:21:00.000-07:00

Involvement of inframammary areas

Hailey -Hailey disease is often complicated by secondary infection.Many times I feel that the infection is the factor that causes the condition to flare.When it is controlled the condition responds again to topical steroids.

This is a Google Scholar search on the topic.

2005-04-04T04:20:00.000-07:00

Close up of the axillae

Role of topical antifungals in the treatment of onychomycosis

2005-04-01T09:18:00.000-08:00

Onychomycosis may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It is caused by three main classes of fungi: dermatophytes, yeasts, and nondermatophyte molds, but the clinical appearance is indistinguishable based on the species of fungus causing the infection. Based on the morphology, major subtypes include distal lateral subungual, white superficial, proximal subungual, and candidal.
Do the topical antifungals have a role in the treatment of onychomycosis? View images

See the following Google search on this question.

Anti histamines for urticaria pigmentosa

2005-03-30T10:18:00.000-08:00

Mastocytosis is a rare disorder characterized by abnormal accumulations of mast cells in skin, bone marrow, and internal organs such as the liver, spleen and lymph nodes. The most common form of the cutaneous mastocytosis is urticaria pigmentosa characterised by the development of multiple brown macules which urticate on rubbing or scratching(Darier sign). Which antihistamines are most effective to control the symptoms of urticaria pigmentosa. Do the mast cell stabilisers have a role? View images

Topicals for oral lichen planus

2005-03-30T10:12:00.000-08:00

Oral lichen planus(OLP) affects approximately 1% to 4% of the population and is seen most commonly in older women. Of the 3 basic clinical morphologies of the disease (reticular, erythematous, and erosive), the last form tends to be more symptomatic and prompts patients to seek treatment. Malignant transformation to squamous cell carcinoma (SCC) is seen in 0.4% to 5% of patients with OLP, particularly those with erosive and erythematous disease. What is your experience with different topicals available to treat oral lichen planus? View images

PubMed eMedicine Dermatology Online Journal on Oral Lichen Planus

Xanthelasma workup

2005-03-30T10:02:00.000-08:00

Xanthelasma or xanthoma palpebrarum are yellow plaques that are usually located on the medial side of the upper eyelids. One half of these lesions have been found to be associated with elevated plasma lipid levels. Histopathological examination shows xanthelasma to be composed of xanthoma cells which are foamy histiocytes laden with intracellular fat deposits of cholesterol primarily within the upper reticular dermis. What lab investigations are advised to further evaluate such cases? View images

PubMed eMedicine Dermatology Online Journal on Xanthelasma

Treatment options for actinic keratoses

2005-03-30T09:50:00.000-08:00

Actinic keratoses are usually found on the sun-exposed areas of the face, the ears, the forearms, and the dorsum of the hands in adults with history of chronic sun exposure. There is often a background of solar-damaged skin with telangiectasias, elastosis, and pigmented lentigines. What are the treatment options for actinic keratoses? View Images

Reddish brown plaques

2005-03-30T09:08:00.000-08:00

This patient with a prolonged history of generalised erythema and photosensitivity complaining of a burning sensation over the exposed areas on sun exposure, developed an asymptomatic generalized eruption comprised of widely disseminated reddish brown infiltrated papulonodules and plaques. Serum protein analysis revealed a raised level of gamma globulins. Histopathology of the biopsy specimen revealed dense dermal infiltration by foamy histiocytes, lymphocytes and plasma cells. What would be the differential diagnosis? View Images

PubMed eMedicine Dermatology Online Journal on Lepromatous leprosy