DERMATOLOGY: MORE THAN SKIN DEEP
AUTHOR Courtney Schadt, MD
NAME
WHAT IS THE DIAGNOSIS?
The following are clinical cases depicting skin signs of internal disease. The
diagnoses are revealed on the following page.
PATIENT 1: A man in his early 30s presented
with a new, slightly pruritic eruption over
the previous few weeks. He had failed oral
antibiotics and was referred for refractory
folliculitis. He reported no medical history and
was not on any medications. On examination,
he had thousands of orange to yellow papules
with an erythematous rim, concentrated over
the extensor surfaces, but diffusely over his
body. PATIENT 2: A woman in her late 50s presented
with a new rash on her face, chest and hands.
She had periorbital erythema and edema, a
violaceous erythema over her chest and back,
raggedy cuticles with dilated capillary loops,
and erythematous papules and plaques over
the joints of the hands.
ANSWER ANSWER
PATIENT 3: A man in his early 50s presented
with an extremely itchy rash on his elbows and
knees for several months duration. His previous
doctor had thought he was just “stressed”
and picking at his skin. He had clusters of
excoriations with a few rare vesicles on his
elbows, knees, and buttocks. He was actively
scratching during his visit. PATIENT 4: A women in her early 50s was
referred by a dermatologist in another state for
a painful rash on her legs, trunk and arms. It
started as painful blisters on her feet and shins
and spread upward. Upon examination, she had
numerous necrotic papules and non-blanching
dark purple macules on the feet, lower legs,
trunk and arms.
ANSWER ANSWER
(continued on page 32)
MAY 2020
31