tag:blogger.com,1999:blog-58254011413299823092024-03-13T11:22:03.386+08:00A Skin Blogby CytodermCytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-5825401141329982309.post-718778078817547942007-07-22T23:50:00.000+08:002007-07-23T00:01:02.024+08:00Bizarre skin condition<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLdUGeoj9X_frueZ-ZyezUx2fP30j5b_zYho4QhGjYgKYfooBsKRjEpi4bUsJbNaIHGK49mxdxBtaRWXLKe4Y1zHSiojWqt5dhZR8EHETJiDM2wuzhXM_ADCpEGO1Y_jlbQDS4rFEaLo0/s1600-h/easterneuropeskincondition1c.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLdUGeoj9X_frueZ-ZyezUx2fP30j5b_zYho4QhGjYgKYfooBsKRjEpi4bUsJbNaIHGK49mxdxBtaRWXLKe4Y1zHSiojWqt5dhZR8EHETJiDM2wuzhXM_ADCpEGO1Y_jlbQDS4rFEaLo0/s400/easterneuropeskincondition1c.jpg" alt="" id="BLOGGER_PHOTO_ID_5090049436714435330" border="0" /></a>Just want to share this interesting picture.<br />I read it in <a href="http://medicine.com.my/wp/?p=2404" target=_blank">MMR</a>.<br />Spotted in <a href="http://www.unboundedmedicine.com/2007/03/16/bizarre-dermatologic-lesions/"target=_blank">Unbounded Medicine</a>.<br />Also in <a href="http://blog.wfmu.org/freeform/2007/03/missionary_enco.html" target="_blank">WFMU</a>.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com53tag:blogger.com,1999:blog-5825401141329982309.post-37844191779991475912007-06-23T21:56:00.001+08:002007-06-23T22:08:32.926+08:00Derm round 24<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnsarmtKxPJWK5JVcgi_Sd4yBcyVeN4ir7BOXqfNemF2ZkZQ3icDm4FyZpTSSnojYf0kVnR68UPS1tWWvjwi6-YwXupyPEGrDwlxJNdo5pSpQAyjsl45fAdEwpyB1D27n0o81UKvlE81A/s1600-h/DSC02145.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnsarmtKxPJWK5JVcgi_Sd4yBcyVeN4ir7BOXqfNemF2ZkZQ3icDm4FyZpTSSnojYf0kVnR68UPS1tWWvjwi6-YwXupyPEGrDwlxJNdo5pSpQAyjsl45fAdEwpyB1D27n0o81UKvlE81A/s400/DSC02145.JPG" alt="" id="BLOGGER_PHOTO_ID_5079258546076252994" border="0" /></a>45 years old lady presented with fever of 5 days duration, associated with chills, rigors, nausea, and bodyache. There was history of dengue outbreak in neighborhood. At day 5, fever resolved and the above rashes appeared mostly over her arms.<br /><br />Clinically, multiple <a href="http://cytoderm.blogspot.com/2007/01/derm-round-2.html" target=_blank">red spots with rim of halo</a> noted over her arms. Full blood count showed leucopenia with lymphocytosis and thrombocytopenia, consistent with viral picture. Dengue IgM was positive.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com2tag:blogger.com,1999:blog-5825401141329982309.post-39024754479168550112007-03-05T20:28:00.000+08:002007-03-05T21:05:15.102+08:00Derm round 23<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl89jVFmqbQRKUr_KK3DZh8JCVMU70sXSHQbZepncG_GaPQFw5OOlCy3XRzVGpAPU3H0uuJjqWDVqW_1VgvaN76fGsCvlC6ZYKur0unp_G6oGuTGuCUwfWeu36iMBhOf1Aa6sIK2aKkws/s1600-h/DSC01468.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl89jVFmqbQRKUr_KK3DZh8JCVMU70sXSHQbZepncG_GaPQFw5OOlCy3XRzVGpAPU3H0uuJjqWDVqW_1VgvaN76fGsCvlC6ZYKur0unp_G6oGuTGuCUwfWeu36iMBhOf1Aa6sIK2aKkws/s400/DSC01468.JPG" alt="" id="BLOGGER_PHOTO_ID_5038418080998415682" border="0" /></a>A 70 years old man was referred to the clinic for further management of multiple pruritic rashes over the body and lower limbs of two years duration.<br /></div><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZ7qbYy64LrKRBiz7HEjMNa-WVhq0J7JKBmKOLfpvusmVQoh0woUOugxQIKCdxL6zykhz_u4VHNRiz-cKAy7Ta1upQckipRTkqsU8biyOK-jtz_NIr-attRoSMFqw0YirsMxU-dlOMXiU/s1600-h/DSC01471.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZ7qbYy64LrKRBiz7HEjMNa-WVhq0J7JKBmKOLfpvusmVQoh0woUOugxQIKCdxL6zykhz_u4VHNRiz-cKAy7Ta1upQckipRTkqsU8biyOK-jtz_NIr-attRoSMFqw0YirsMxU-dlOMXiU/s400/DSC01471.JPG" alt="" id="BLOGGER_PHOTO_ID_5038417106040839474" border="0" /></a>The lesions over the body and lower limbs appeared well-demarcated erythematous rashes with scaling and excoriation. In addition, he has generalized skin dryness (xerosis).<br /></div><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJtI12ngfU4HLP1GcUD2t-WqYdfVlT4HbW7hzKTyWTQepm10YuQE-_UGL_zeQbvn1Sa-i1wcOcRDN7PtC_OglAmf6ZVGWXhZgazDlIeRhvEgbyzpEbGoAoj5n0eOYRigCVlrOfecl8bwk/s1600-h/DSC01469.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJtI12ngfU4HLP1GcUD2t-WqYdfVlT4HbW7hzKTyWTQepm10YuQE-_UGL_zeQbvn1Sa-i1wcOcRDN7PtC_OglAmf6ZVGWXhZgazDlIeRhvEgbyzpEbGoAoj5n0eOYRigCVlrOfecl8bwk/s400/DSC01469.JPG" alt="" id="BLOGGER_PHOTO_ID_5038416938537114914" border="0" /></a>I would have dismissed the case as 'another chronic eczema', until I find these lesions over the anterior chest.<br /></div><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXxBfBm5rbbV8Sv7SHGuv23jF8dFHHJVRTwhcIUAQzuz0zzU8aTViyWzHZSaaXn3StmCqfGe95CQEuKC3IEXg_09sVuN0cJnA0sQWKfbarw4De6LP5FyPREtkENKfFWx3QfQiLYWLj5AE/s1600-h/DSC01470.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXxBfBm5rbbV8Sv7SHGuv23jF8dFHHJVRTwhcIUAQzuz0zzU8aTViyWzHZSaaXn3StmCqfGe95CQEuKC3IEXg_09sVuN0cJnA0sQWKfbarw4De6LP5FyPREtkENKfFWx3QfQiLYWLj5AE/s400/DSC01470.JPG" alt="" id="BLOGGER_PHOTO_ID_5038416736673651986" border="0" /></a>A large ring-like lesion with central paling. There was reduced pin-prick sensation.<br /></div><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQWgcOxVcWZVhyphenhyphen5XDwvkHibqOYP7gIg5DyTaen8kE4RCHJZUNqb-2iimHBW4NcD4Agne3iySTVvYYkZqQmFmSpnUZG9JQij2H7u7iCqdzEr1bQ29uoEOpzSq3fbVAPuIjrhU9tsY_hThs/s1600-h/DSC01472.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQWgcOxVcWZVhyphenhyphen5XDwvkHibqOYP7gIg5DyTaen8kE4RCHJZUNqb-2iimHBW4NcD4Agne3iySTVvYYkZqQmFmSpnUZG9JQij2H7u7iCqdzEr1bQ29uoEOpzSq3fbVAPuIjrhU9tsY_hThs/s400/DSC01472.JPG" alt="" id="BLOGGER_PHOTO_ID_5038416543400123650" border="0" /></a>He also has this hand appearance, fixed flexion deformities of the right 4th and 5th fingers; suggesting of an ulna nerve lesion. The ulna nerve was thick on palpation. In addition, he has sparce eyebrows.<br /></div><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqLzVPbot2LcyL-xsonAeaxvESOiPhH0nxhWALXjy6Jy9Ur7RXLdHKzorAy0PDDuJuGcLX57xkruW0tSNrSNYh-3La_PMlTJ25M2-Ni_0lyhJ1BHMWciZUvL04GpDFQNvOkNS67OcxI7Y/s1600-h/cyto1.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqLzVPbot2LcyL-xsonAeaxvESOiPhH0nxhWALXjy6Jy9Ur7RXLdHKzorAy0PDDuJuGcLX57xkruW0tSNrSNYh-3La_PMlTJ25M2-Ni_0lyhJ1BHMWciZUvL04GpDFQNvOkNS67OcxI7Y/s400/cyto1.JPG" alt="" id="BLOGGER_PHOTO_ID_5038418222732336466" border="0" /></a>Slit-skin smears confirmed the diagnosis.<br />(<span style="font-size:78%;">Pic taken with my SE750</span>)<br /><div style="text-align: left;"><br /><a href="http://www.emedicine.com/derm/topic223.htm" target="_blank"">eMedicine</a><br /><a href="http://www.who.int/mediacentre/factsheets/fs101/en/" target="_blank"">WHO</a><br /><a href="http://www.leprosy-review.org.uk/" target="_blank"">Leprosy Review</a><br /><a href="http://dermnetnz.org/bacterial/leprosy.html" target=_blank">DermNet NZ</a><br /></div></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com2tag:blogger.com,1999:blog-5825401141329982309.post-51877924187055354452007-02-28T23:25:00.000+08:002007-02-28T23:51:42.900+08:00Derm round 22<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHVqMzKxnU_31fcP1she3Su8Tq4LuEXzuZLOgfaj2P3_eenIDECahGY4LEllOj559xOAqq08Z8g7ByzJMFsfUakMxrKI-qSnKCmF6DdEz940vEA0pZnJzvB5wmXccc1bJBdyfLEzwptIQ/s1600-h/DSC01394.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHVqMzKxnU_31fcP1she3Su8Tq4LuEXzuZLOgfaj2P3_eenIDECahGY4LEllOj559xOAqq08Z8g7ByzJMFsfUakMxrKI-qSnKCmF6DdEz940vEA0pZnJzvB5wmXccc1bJBdyfLEzwptIQ/s400/DSC01394.JPG" alt="" id="BLOGGER_PHOTO_ID_5036613011081241426" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEj1M-2BOzBEydJ9OTEaBTJQC1xyV9elc-kdg2ZetTr3HX3cooBrC_ZgZqJ2e-Jg5J7QzR3fGONNM-4iWQuqy9AMeiKVRfbZm6QnRpexLuEPC8moEKn7lKZgKo8VZE7noi8FeskwbSai0/s1600-h/DSC01392.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEj1M-2BOzBEydJ9OTEaBTJQC1xyV9elc-kdg2ZetTr3HX3cooBrC_ZgZqJ2e-Jg5J7QzR3fGONNM-4iWQuqy9AMeiKVRfbZm6QnRpexLuEPC8moEKn7lKZgKo8VZE7noi8FeskwbSai0/s400/DSC01392.JPG" alt="" id="BLOGGER_PHOTO_ID_5036607264414999346" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXo__gqtww7zClnwv2oZ1H_bq1xqmcsY6ageBffC3e43PTAdlEvTRQ0yLrCT0kpqSTO_FkslevE2poHKV0H1_sjtg-8hPTlNMjLobPtswWTYKxePIoInGIXcw8KB_Tl4E0H25-PQIIFT8/s1600-h/DSC01395.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXo__gqtww7zClnwv2oZ1H_bq1xqmcsY6ageBffC3e43PTAdlEvTRQ0yLrCT0kpqSTO_FkslevE2poHKV0H1_sjtg-8hPTlNMjLobPtswWTYKxePIoInGIXcw8KB_Tl4E0H25-PQIIFT8/s400/DSC01395.JPG" alt="" id="BLOGGER_PHOTO_ID_5036607023896830754" border="0" /></a>13 months old baby boy was admitted to the ward for prolonged fever. Clinically, he has hepato-splenomegaly. Full blood count showed pancytopenia. Peripheral blood film and the bone marrow aspirate were unremarkable. "Biohazard" screenings were all negative. Blood C&S has no growth and the rest of the investigations were unremarkable.<br /><br />He was treated empirically with IV antibiotic (Cloxacillin and Ceftriaxone). After one week in the ward, and the temperature was still spiking, he developed numerous small papular lesions over the body and more marked over the lower limbs.<br /><br />On examination, there were monomorphic, skin-colored, small papular eruptions, scattered over the face, body, upper limbs and numerously over the lower limbs (see pictures).<br /></div><br />What is it?<br />We were thinking, more of molluscum contagiosum.<br /><br />But the paediatricians thought otherwise, ? Gianotti-Crosti syndrome.<br /><br />See:<br /><a href="http://www.emedicine.com/derm/topic165.htm" target="_blank"">eMedicine</a><br /><a href="http://dermnetnz.org/viral/gianotti-crosti.html" target="_blank"">DermNet NZ<br /></a>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-44510007078041071652007-02-25T18:42:00.000+08:002007-02-25T18:49:42.918+08:00Derm round 21<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiSdSc6M15BCkckZUs9ey_xOfkfm6rbpKkYhGl15WRqlYKVWbyDQUR-9dK3RwquhFD8EfowLZ0F5s1BHEAwC5oN82dvhUjTlkJ1VR3uQKMf4ErapF9waTDZzjAF-wn5Uj9iblijSDgAs/s1600-h/DSC01410.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiSdSc6M15BCkckZUs9ey_xOfkfm6rbpKkYhGl15WRqlYKVWbyDQUR-9dK3RwquhFD8EfowLZ0F5s1BHEAwC5oN82dvhUjTlkJ1VR3uQKMf4ErapF9waTDZzjAF-wn5Uj9iblijSDgAs/s400/DSC01410.JPG" alt="" id="BLOGGER_PHOTO_ID_5035420865146793122" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuT-iPKfSOw9Nx2clbB4j1AGu1-iCdN5klrWm_jsbxPmn0qvVoQ7pf3V0F06p5jr5K42eGTNWcaWfkxeYVreTXj4hhYAvqDsXggxD-7Rk3jGff_KXTDeYDKjNWvRjScCEP345Ll-6Q7h0/s1600-h/DSC01412.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuT-iPKfSOw9Nx2clbB4j1AGu1-iCdN5klrWm_jsbxPmn0qvVoQ7pf3V0F06p5jr5K42eGTNWcaWfkxeYVreTXj4hhYAvqDsXggxD-7Rk3jGff_KXTDeYDKjNWvRjScCEP345Ll-6Q7h0/s400/DSC01412.JPG" alt="" id="BLOGGER_PHOTO_ID_5035420624628624530" border="0" /></a>14 years old boy presented with the above lesions over the sole for 7 months.<br /><br />Spot diagnosis?<br />See related <a href="http://cytoderm.blogspot.com/search/label/pitted%20keratosis" target="blank">post</a>.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-48611643571999308882007-02-24T21:08:00.000+08:002007-02-24T21:38:05.572+08:00Derm round 20<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD3h-WxeNLK5zpkQWLwWQ1FMMgDD97drT3DmU2BfKVA2vRj_qJpGyx0zDcAAiRB6YsK1j3bjg1pcmH5OcNJVaIEY-FEC1Nz4DqyAn6bzx3I8Z8klGMJ-9JyCdd7PKIr8ag9_4qzp1QIgk/s1600-h/DL1.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD3h-WxeNLK5zpkQWLwWQ1FMMgDD97drT3DmU2BfKVA2vRj_qJpGyx0zDcAAiRB6YsK1j3bjg1pcmH5OcNJVaIEY-FEC1Nz4DqyAn6bzx3I8Z8klGMJ-9JyCdd7PKIr8ag9_4qzp1QIgk/s400/DL1.JPG" alt="" id="BLOGGER_PHOTO_ID_5035087923576974466" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsbOuwFMpepg8uUt7auvzxx3ThDj4Hq2T2Zg4QiNF5cCtsPwEARD5tcp1ubQX9UP5kklzexFCPDBeJhiuDX_K1Dj4NLoMYOYe-P1BZB1HTRN5hm6yCpiMItbp5NwsWBSEdOhpqchclGwo/s1600-h/DSC01390.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsbOuwFMpepg8uUt7auvzxx3ThDj4Hq2T2Zg4QiNF5cCtsPwEARD5tcp1ubQX9UP5kklzexFCPDBeJhiuDX_K1Dj4NLoMYOYe-P1BZB1HTRN5hm6yCpiMItbp5NwsWBSEdOhpqchclGwo/s400/DSC01390.JPG" alt="" id="BLOGGER_PHOTO_ID_5035087691648740466" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKyHB4XEdQYQD5ZE_P2ndK5qRVsQS1XRauvxpVyhG-pEWjfJMsugrQv_bV61IjGe333_PpI6W2neumEn2VEU8_YdW6k6xH2yXCTfusEMG6kTtpNT41ssit97NBlJib_k61UOHk3IB2SBo/s1600-h/DSC01388.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKyHB4XEdQYQD5ZE_P2ndK5qRVsQS1XRauvxpVyhG-pEWjfJMsugrQv_bV61IjGe333_PpI6W2neumEn2VEU8_YdW6k6xH2yXCTfusEMG6kTtpNT41ssit97NBlJib_k61UOHk3IB2SBo/s400/DSC01388.JPG" alt="" id="BLOGGER_PHOTO_ID_5035087352346324066" border="0" /></a>27 years old gentleman presented with the above erythematous rashes over the malar region and alopecia of one year duration. There was no photosensitivity, oral ulcer or joint pain. Review of other system was unremarkable.<br /><br />On examination, there was erythematous and slightly scaly lesion over the malar eminence as well as over the scalp. Similar lesions were also noted over the forearms and the back of trunk with areas of scarring. In addition, there was also scarring alopecia noted.<br /><br />Diagnosis?<br /><a href="http://www.emedicine.com/derm/topic247.htm" target="_blank"">Discoid lupus</a>.<br /><br />More:<br /><a href="http://dermnetnz.org/immune/cutaneous-lupus.html" target="_blank"">DermNet NZ</a><br /><a href="http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1416604090" target="_blank"">DermAtlas</a><br /><a href="http://www.bad.org.uk/patients/leaflets/discoid.asp" target="_blank"">BAD</a><br /><a href="http://www.lupus.org.uk/article.php?i=131" target="_blank"">lupus.org.uk</a><br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-48940664131604688952007-02-23T21:59:00.000+08:002007-02-24T21:37:44.504+08:00Derm round 19<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhs7d0egv-SHI4OjBl6ryGuTR-3C-ierTLvT3x2qbzWrIm_f_sAbSXEvG4STB8pnSk75sN4KEjgE6g2tNZMVbWt8y6l4EQ1F9eGO4hIJ7si0joWgfv-LaLLziigWDe5EvSginU_S5O_Y0g/s1600-h/DSC01376.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhs7d0egv-SHI4OjBl6ryGuTR-3C-ierTLvT3x2qbzWrIm_f_sAbSXEvG4STB8pnSk75sN4KEjgE6g2tNZMVbWt8y6l4EQ1F9eGO4hIJ7si0joWgfv-LaLLziigWDe5EvSginU_S5O_Y0g/s400/DSC01376.JPG" alt="" id="BLOGGER_PHOTO_ID_5034729220793314338" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMyXJubRAUd1kYRJVOP6pUxUokByThJnW7KkCvnyOR1eS3RO0WU5yOV1CjDS9XW8aUiZbDQQjZGQpUcihUPCrEMFK2L9pXFiNGB6TdXDqCAKzntqKGPT45PnKiXBlXyNkbALJOUQDxvL0/s1600-h/DSC01380.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMyXJubRAUd1kYRJVOP6pUxUokByThJnW7KkCvnyOR1eS3RO0WU5yOV1CjDS9XW8aUiZbDQQjZGQpUcihUPCrEMFK2L9pXFiNGB6TdXDqCAKzntqKGPT45PnKiXBlXyNkbALJOUQDxvL0/s400/DSC01380.JPG" alt="" id="BLOGGER_PHOTO_ID_5034730784161410130" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgv0m5HHRAKfMwyjkrWNWtnfXpMFQD7a2N7la53M8ttBDbJ7KxzqLZM9gZy1WemOFGzJne29mqfDGEcYm8gCgJ4xn2ggm6XZ9NpiL283BzAaEPBViyWDSavpVrOQAmDxaI7XIZ32UEt61g/s1600-h/DSC01377.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgv0m5HHRAKfMwyjkrWNWtnfXpMFQD7a2N7la53M8ttBDbJ7KxzqLZM9gZy1WemOFGzJne29mqfDGEcYm8gCgJ4xn2ggm6XZ9NpiL283BzAaEPBViyWDSavpVrOQAmDxaI7XIZ32UEt61g/s400/DSC01377.JPG" alt="" id="BLOGGER_PHOTO_ID_5034730543643241522" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimNI0SyPAhYJQkDu3Y5ykmpLUkPfgKIc50TQxh7FZrJemGmGZu-7XcwslkxM3Q7jX70w7AiD8vTfRdUNcxPEkuy400bZV4vGnL7IBqK78T5ryVdtolnAE5a8A8TV4wVzqMtB_xvulkF1w/s1600-h/DSC01379.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimNI0SyPAhYJQkDu3Y5ykmpLUkPfgKIc50TQxh7FZrJemGmGZu-7XcwslkxM3Q7jX70w7AiD8vTfRdUNcxPEkuy400bZV4vGnL7IBqK78T5ryVdtolnAE5a8A8TV4wVzqMtB_xvulkF1w/s400/DSC01379.JPG" alt="" id="BLOGGER_PHOTO_ID_5034730547938208834" border="0" /></a>50 years old gentleman, presented to me with the above lesions over his hands and feet of one month duration. He gave history of washing the floor mat with concentrated bleach solution three days before he started developing such lesions. He also stepped on the mat as well.<br /><br />Clinically, the lesions appeared well-defined, dried and scaly with cracks, on an erythematous base. There were also maculo-papular rashes over the body. There was no scalp involvement or nail changes. Fungal scrapping was negative.<br /><br />Although from the history, it sounded like contact dermatitis, clinically, the lesions appeared more "psoriatic". Furthermore, the lesions were more extensive and involved other non-exposure sites (body).<br /><br />Diagnosis?<br />?Allergic contact dermatitis.<br />?Psoriasiform dermatitis.<br /><br />Anyway, I treated him as having contact dermatitis.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-5574539930872694272007-02-22T19:20:00.000+08:002007-02-22T19:47:00.413+08:00Derm round 18<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikV9wDSI4BXa2JXCurXmtqxeITaJ2J4S2Ptm79WSnLDg1LS_gqQAFI-8mM8wff23ifBNnTj5BL_RCvLvNSdJoNjf2sc8JR-_PUeOenSqk0RTcYn0EmYdGw0Rw9UtsmAj7EMSwxMPLhqO0/s1600-h/DSC01306.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikV9wDSI4BXa2JXCurXmtqxeITaJ2J4S2Ptm79WSnLDg1LS_gqQAFI-8mM8wff23ifBNnTj5BL_RCvLvNSdJoNjf2sc8JR-_PUeOenSqk0RTcYn0EmYdGw0Rw9UtsmAj7EMSwxMPLhqO0/s400/DSC01306.JPG" alt="" id="BLOGGER_PHOTO_ID_5034318299797269522" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5DJik8NPRdlYkm_vxWS6eT3BPFx5GWjP2Xvg-kXHdtSu7F1DNFqiGIExDc4BOnI9G1nj9L3jXcsjB2bQKLC1Joc5dNMgAENzG0ycqwmve_-Lx4jooXRhGJIPQOC9BHFkuOG74NNvtB_c/s1600-h/DSC01303.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5DJik8NPRdlYkm_vxWS6eT3BPFx5GWjP2Xvg-kXHdtSu7F1DNFqiGIExDc4BOnI9G1nj9L3jXcsjB2bQKLC1Joc5dNMgAENzG0ycqwmve_-Lx4jooXRhGJIPQOC9BHFkuOG74NNvtB_c/s400/DSC01303.JPG" alt="" id="BLOGGER_PHOTO_ID_5034318042099231746" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirGgcqwI0ploCUKU99Yc6lNJZY7_oFy3k5lkgS0VkSGV5EcLy0RCWc0NFh79GXCfGXJwRyJGrq5r_WKMlGJR1RcO9Bmj4MYRUwL83dheqC4X22wAYD01sCM5nOn8sV2o-ipa0L5F57asY/s1600-h/DSC01304.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirGgcqwI0ploCUKU99Yc6lNJZY7_oFy3k5lkgS0VkSGV5EcLy0RCWc0NFh79GXCfGXJwRyJGrq5r_WKMlGJR1RcO9Bmj4MYRUwL83dheqC4X22wAYD01sCM5nOn8sV2o-ipa0L5F57asY/s400/DSC01304.JPG" alt="" id="BLOGGER_PHOTO_ID_5034317900365310962" border="0" /></a>46 years old lady presented with the above very pruritic lesions over the body of two months duration. She is a hawker selling Char Koay Teow by the road side. On examination, there were extensive papular lesions over the forearms, lower limbs, neck and body especially over the sun exposed areas.<br /><br />Diagnosis?<br />We are treating her as having some form of <a href="http://www.umm.edu/altmed/ConsConditions/SkinDisordersPhotodermatitiscc.html" target=_blank">photodermatitis</a> or <a href="http://dermnetnz.org/reactions/pmle.html" target=_blank">polymorphic light eruption</a>.<br /><br />She was given Betnovate 1:6 cream, aques cream as emollient and anti-histamine. However, her response was unsatisfactory, with persistent disturbing pruritic lesions. One factor contributing to her condition was, she still works by the roadside and wear T-shirt with short pants despite been advice against doing so.<br /><br />Any comment or suggestion?<br /><br />More:<br /><a href="http://www.bad.org.uk/public/leaflets/ple.asp" target=_blank">BAD</a><br /><a href="http://www.emedicine.com/derm/topic342.htm" target=_blank">eMedicine</a><br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com3tag:blogger.com,1999:blog-5825401141329982309.post-52876960494110382007-02-21T09:25:00.000+08:002007-11-12T19:43:09.283+08:00Update (On Derm round 1)<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsjGmnONhIdHH1_F3phDVyDRkAxesFr27kS1Yr98gb7Su3eQwZEGcZpc5qovwr7SuOj2vW_YPIIulxLjlweVkDz97hS1Trw0fzLGIB-fo1vI7Du6cVm0pwlo9Lx4u2wzB7bgbt8s7S_fQ/s1600-h/DSC01293.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsjGmnONhIdHH1_F3phDVyDRkAxesFr27kS1Yr98gb7Su3eQwZEGcZpc5qovwr7SuOj2vW_YPIIulxLjlweVkDz97hS1Trw0fzLGIB-fo1vI7Du6cVm0pwlo9Lx4u2wzB7bgbt8s7S_fQ/s400/DSC01293.JPG" alt="" id="BLOGGER_PHOTO_ID_5033794047499185122" border="0" /></a>This lady presented with granulomatous lesions over the face of 6 months duration (<a href="http://cytoderm.blogspot.com/2007/02/derm-round-11.html" target="blank">Derm round 11</a>). She had a skin biopsy done and was empirically covered with T. EES (Erythromycin) 400mg BD for two weeks.<br /><br />Her biopsy was later reported as <span style="color: rgb(255, 153, 255);">chronic granulomatous lesion, suggestive of atypical mycobateria infection</span>.<br /><br />On two weeks follow-up, surprisingly, the lesions had flattened >50% with areas of scaling and crusting.<br /><br />We extended another two weeks of EES and will be discussing her HPE in the next combine meeting. KIV may need to start on anti-TB if indicated.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com2tag:blogger.com,1999:blog-5825401141329982309.post-24025330077935932882007-02-17T23:22:00.000+08:002007-03-02T16:02:46.197+08:00Derm round 17<div style="TEXT-ALIGN: justify"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivWNwL1gREKdzSu9pwx0UeG86JaIWCJyxH4ULYI_mv55TLw5Q1BWGIi6koLzcC2s_bp7K3k-EdYUVbgHQUj5GuwPhxH2RPkM44soZTXdyor43wv45pak67m7ZZJwjkgW_WC7ki-HVgOCA/s1600-h/DSC01298.JPG"><img id="BLOGGER_PHOTO_ID_5032524049240344898" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: pointer; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivWNwL1gREKdzSu9pwx0UeG86JaIWCJyxH4ULYI_mv55TLw5Q1BWGIi6koLzcC2s_bp7K3k-EdYUVbgHQUj5GuwPhxH2RPkM44soZTXdyor43wv45pak67m7ZZJwjkgW_WC7ki-HVgOCA/s400/DSC01298.JPG" border="0" /></a>50 years old gentleman, presented with right gluteal swelling of one year duration. The swelling bled easily on physical contact. He had symptoms of anaemia with loss of weight but normal apetite.<br /><br />Clinically, the tumor is cauliflower-liked with ulceration and area of bleeding spots.<br /><br />He was referred to dermatologist for opinion because of the HPE report:<br /><span style="COLOR: rgb(51,255,255)">Section showed skin with underlying spindle shaped illed-define lesion. The cells show a storiform pattern of arrangement. The cells have moderately pleomorphic muclei and few mitotic figures are seen. Foamy macrophages are noted with occasional large bizarre cells. The is no necrosis noted. There is no evidence of malignancy in this biopsy</span>. <span style="COLOR: rgb(255,0,0)">Diagnosis: Benign fibrous histiocytoma</span>.<br /></div><br /><div style="TEXT-ALIGN: justify">However clinically, the lesion looked aggressive. There were multiple inguinal lymph nodes felt. No organomegaly felt. His Hb was 5.9 gm/dl. Other blood investigations were unremarkable. His chest X-ray was normal. CT scan of the lesion showed a soft tissue mass arising from the skin. CT scan chest/abdomen/pelvis revealed multiple lung nodules, inguinal lymphadenopathy and right ilium bone erosion.<br /><br />In view of the clinical findings, this tumour behaved as malignant with evidence of metastasis.<br /><br />A repeat biopsy was done on 13/2/2007.<br /><br />Read:<br /><a href="http://www.maxillofacialcenter.com/BondBook/softtissue/fibroushisto.html" target="'_blank">Fibrous histiocytoma</a><br /><a href="http://atlasgeneticsoncology.org/Tumors/CutanFibrousHisID5092.html" target="'_">Atlas of genetics and cytogenetics in oncology and haematology</a><br /><a href="http://www.gpnotebook.co.uk/cache/134610965.htm" target="'_blank">GpNotebook</a><br /><a href="http://www.emedicine.com/radio/topic420.htm" target="'_blank">Malignant fibrous histiocytoma<br /></a></div><p></p><p></p><p></p><p><a href="http://www2.blogger.com/www.orthopaediccare.net/view/templates/Chapter_Text.asp?chapterid=onc4133aa&p=0" target="'_blank"><br /></a></p><p align="justify"><br /><br />Update (2/3/2007):<br />Repeat biopsy report:<br /><span style="color:#ffff33;">Sections show skin tissue with underlying dermis. A diffuse cellular lesion is noted in the dermis. The lesion composed of spindle-shaped cells arranged in stori-form pattern. The spindle-shaped to plump cells exhibit mild to moderate pleomorphic vesicular nuclei and prominent nucleoli. Mitotic figures are seen. Infiltration by acute and chronic inflammatory cells is noted.</span><br />Immunohistochemical stain: <span style="color:#33ccff;">The spindle-shaped cells are positive for vimentin</span>.<br />Diagnosis: <span style="color:#ff0000;">Dermatofibrosarcoma protuberans</span>.</p>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-53654470410884837772007-02-15T20:21:00.000+08:002007-02-15T21:28:58.913+08:00Derm round 16<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1edqgIS8duH8ho6d7tFVVtEQNBgZrR6EHpJO4Y2FzavA-56rGvZMvMLkc3JL6eANddqOnxTlggJKiCTKbfplpblM-ZlTsoe-0KfZpCbKpiypODLnh3ERgVZunLlC7A61J5PxzolkHWTY/s1600-h/DSC01295.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1edqgIS8duH8ho6d7tFVVtEQNBgZrR6EHpJO4Y2FzavA-56rGvZMvMLkc3JL6eANddqOnxTlggJKiCTKbfplpblM-ZlTsoe-0KfZpCbKpiypODLnh3ERgVZunLlC7A61J5PxzolkHWTY/s400/DSC01295.JPG" alt="" id="BLOGGER_PHOTO_ID_5031751908609804594" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL7trgkfsvLMyEFtDswTblAsVfziYUzSXDQl9nGQAWFTjhC-luE-x7aF6NRQ3E50q8CirvcSW30l82OQVvmhxa5nXoQ0cMyEaup784pNQEwiFxKiDkDtfMCwOaZtZlwbp3uA-ewmnA8DE/s1600-h/DSC01294.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjL7trgkfsvLMyEFtDswTblAsVfziYUzSXDQl9nGQAWFTjhC-luE-x7aF6NRQ3E50q8CirvcSW30l82OQVvmhxa5nXoQ0cMyEaup784pNQEwiFxKiDkDtfMCwOaZtZlwbp3uA-ewmnA8DE/s400/DSC01294.JPG" alt="" id="BLOGGER_PHOTO_ID_5031751741106080034" border="0" /></a><br /><br /><br /><br /><br />Diagnosis?<br />Acute generalized erythematous pustulosis (AGEP).<br /><br /><div style="text-align: justify;">The above patient was admitted for an elective surgery of left obstructive uropathy due to ureteric calculi. On third day, she developed spiking temperature in the ward, and thus the procedure was cancelled. She was empirically started on IV Cefoperazone. She then developed the above small pustular lesion over the limbs as well as some scattered lesions over the trunk after two days. Blood investigations were unremarkable.<br /><br />On review of her old notes, she was diagnosed as having AGEP two months before, and responded to a course of oral Itraconazole.<br /><br />Assuming that she might be having similar candida infection, she was prescribed Itraconazole again. However, the lesions resolved completely the next day before Itraconazole was managed to be given. The antibiotic was stopped and she became afebrile.<br /><br />Is the AGEP due to Cefoperazone or due to infection?<br /><br /><br /><br />More:<br /><a href="http://www.mja.com.au/public/issues/184_11_050606/pen11149_fm.html" target="_blank"">AGEP due to herbal remedy</a>.<br /><a href="http://www.ijdvl.com/article.asp?issn=0378-6323;year=2001;volume=67;issue=2;spage=93;epage=95;aulast=Criton" target="blank">IJDVL</a>.<br /><a href="http://archderm.ama-assn.org/cgi/content/abstract/127/9/1333" target="_blank"">Archieve of Dermatology</a>.<br /><a href="http://regiscar.uni-freiburg.de/diseases/agep/index.html" target="_blank"">RegiScar Project</a>.<br /><a href="http://www.scielo.br/pdf/rimtsp/v47n3/a11v47n3.pdf" target="blank">Rev. Inst. Med trop. S. Paulo</a>.<br /><a href="http://dermatology.cdlib.org/126/case_presentations/agep/teixeira.html" target="blank">Dermatology Online Journal</a>.<br /><a href="http://www.medscape.com/viewarticle/467070" target="_blank"">Medscape</a>.<br /><br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com3tag:blogger.com,1999:blog-5825401141329982309.post-33755396402468468402007-02-15T19:46:00.000+08:002007-02-15T20:21:16.955+08:00Derm round 15<span style="font-size:180%;">Case 1</span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitY3bZGzgIaypbjqUp2BQko9-R_gOZO9ULBO2vsPAfSCdJ7eq5mSOl5qEDeEIOwGCSCLH4hrOke8c0ltpKEcAaYJFm8ZpIGObUJKR9oduJ_0fUb21IiMxTK3bADpDA-sazs2JyTM4ABd0/s1600-h/DSC01285.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitY3bZGzgIaypbjqUp2BQko9-R_gOZO9ULBO2vsPAfSCdJ7eq5mSOl5qEDeEIOwGCSCLH4hrOke8c0ltpKEcAaYJFm8ZpIGObUJKR9oduJ_0fUb21IiMxTK3bADpDA-sazs2JyTM4ABd0/s400/DSC01285.JPG" alt="" id="BLOGGER_PHOTO_ID_5031730180370254034" border="0" /></a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_SKmxv9soxUk-CDyZZTP66spI2RwTjH_mOF4G6-Ol-cwgVxKkrybG6JNRBmZw2W2Qdw_xXa0o8-phlrI0tyA2FMuj2PPtd5rDRwvvtDrYW7eijjW5fjYE_htr6bj7v3rXPc6uiSp0MtA/s1600-h/DSC01286.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_SKmxv9soxUk-CDyZZTP66spI2RwTjH_mOF4G6-Ol-cwgVxKkrybG6JNRBmZw2W2Qdw_xXa0o8-phlrI0tyA2FMuj2PPtd5rDRwvvtDrYW7eijjW5fjYE_htr6bj7v3rXPc6uiSp0MtA/s400/DSC01286.JPG" alt="" id="BLOGGER_PHOTO_ID_5031726598367529154" border="0" /></a>14 years old girl, had the above lesions since birth.<br /><br />Diagnosis?<br /><a href="http://www.emedicine.com/plastic/topic391.htm" target=_blank">Congenital nevomelanocytic nevus, giant</a>.<br /><br />See also:<br /><a href="http://www.emedicine.com/derm/topic903.htm" target=_blank">Congenital nevi</a>.<br /><br /><br /><span style="font-size:180%;">Case 2</span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq2rIwwcp6-5U3QVAkMPzCGoxUyDP6Xqk1Gk9XdZ2tCUNXV5VPjpOY_Jcz2XLh63mcyBSIvo9Kk11bgCkE5pxI4DNoMeA_lPOwMT9g1Yao7uMRQKBoJZaX5OVYG4QWSNf9AY7IswTwsuk/s1600-h/DSC01292.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq2rIwwcp6-5U3QVAkMPzCGoxUyDP6Xqk1Gk9XdZ2tCUNXV5VPjpOY_Jcz2XLh63mcyBSIvo9Kk11bgCkE5pxI4DNoMeA_lPOwMT9g1Yao7uMRQKBoJZaX5OVYG4QWSNf9AY7IswTwsuk/s400/DSC01292.JPG" alt="" id="BLOGGER_PHOTO_ID_5031731245522143458" border="0" /></a>45 years old gentleman presented with the above pruritic lesion over the scrotum. Fungal scrapping was negative.<br /><br />Diagnosis?<br /><a href="http://www.emedicine.com/derm/topic236.htm" target=_blank">Lichen simplex chronicus</a>.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-85739581290851101532007-02-12T22:57:00.000+08:002007-02-12T23:04:33.405+08:00Derm round 14<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVh9Th3jfxjk6MQBERSz10tC49z7Mo6ngKw7Ii3A46EwEqiDSCymDRXqxKh1XsX_4ebVY5zKwZ0fEYbtNjw8k-eZ2fU9ikCyR_86KoMjLl8LFRhjVZ2rQNCVaDWhZQQj0i-vKUMlrBSk0/s1600-h/DSC01251.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVh9Th3jfxjk6MQBERSz10tC49z7Mo6ngKw7Ii3A46EwEqiDSCymDRXqxKh1XsX_4ebVY5zKwZ0fEYbtNjw8k-eZ2fU9ikCyR_86KoMjLl8LFRhjVZ2rQNCVaDWhZQQj0i-vKUMlrBSk0/s400/DSC01251.JPG" alt="" id="BLOGGER_PHOTO_ID_5030662150852757682" border="0" /></a>This eight years old boy has the above non-pruritic scalp lesions since infancy. He currently presented because the mother noted significant hair loss of one month duration. The lesions are very scaly plague with ill-defined borders. Wood's lamp and fungal scrapping were negative.<br /></div><br />What is it?<br />I treated the patient for <a href="http://www.emedicine.com/derm/topic396.htm" target=_blank">Seborrheic capitis</a> (seborrheic dermatitis of the scalp).Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-174972334370323752007-02-12T22:43:00.000+08:002007-02-09T16:53:08.136+08:00Derm round 13<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRabkWvvXIQiEIIqqRcRf2C6X5WJbITIeiSbmLAXa8rsYBjjgu0eJcfD0yf9m-2DXW2XfqlIf8zQJ3mO57iPAgd8HnyazQ2_N8AKUm9M6CDBg30VbgWNbYvQYfutrBITQZZvfoEM_vQug/s1600-h/DSC01246.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRabkWvvXIQiEIIqqRcRf2C6X5WJbITIeiSbmLAXa8rsYBjjgu0eJcfD0yf9m-2DXW2XfqlIf8zQJ3mO57iPAgd8HnyazQ2_N8AKUm9M6CDBg30VbgWNbYvQYfutrBITQZZvfoEM_vQug/s400/DSC01246.JPG" alt="" id="BLOGGER_PHOTO_ID_5030660089268455586" border="0" /></a>This 9 years old girl, presented with the above non-pruritic lesion of 2 months duration. It is a well-defined, slightly erythematous and scaly lesion. Wood's lamp was negative and fungal scrapping was negative.<br /></div><br />What is it?<br />? <a href="http://www.emedicine.com/ped/topic1813.htm" target="_blank"">Pityriasis alba</a>.<br /><br />What other differentials?<br /><br />By the way, I gave her Hydrocortisone ointment.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-15421043206859185062007-02-09T16:21:00.000+08:002007-02-09T16:18:35.524+08:00Pompholyx<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2PMVBtckfS2-rwR91yns6KP_EqLL92dkoXEnX2N_-XtxVkfTPU8Zc3Z8oYNqImxEZVaSft2etVWbeMLFdhpCzdThY30lB_kNNcEosOjfR0v6HsZhLhU_ASqa3uMLn6GRm8qZ3kN2qBwE/s1600-h/DSC01245.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2PMVBtckfS2-rwR91yns6KP_EqLL92dkoXEnX2N_-XtxVkfTPU8Zc3Z8oYNqImxEZVaSft2etVWbeMLFdhpCzdThY30lB_kNNcEosOjfR0v6HsZhLhU_ASqa3uMLn6GRm8qZ3kN2qBwE/s400/DSC01245.JPG" alt="" id="BLOGGER_PHOTO_ID_5029446778187204754" border="0" /></a>19 years old student presented with the aboce very pruritic small vesicular lesions of both hands of two days duration.<br /><br />Diagnosis?<br />Acute eczema, <a href="http://www.emedicine.com/derm/topic110.htm" target=_blank">dyhidrotic eczematous dermatitis</a>, <a href="http://www.emedicine.com/derm/topic608.htm" target=_blank">vesicular palmar eczema</a>.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-92193239542697282712007-02-09T15:54:00.000+08:002007-02-07T12:15:14.037+08:00Chromoblastomycosis<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3mbvwJOXFWzHF5vcWFqvE0ErFdPhPYh_9kwxsAT9aQplxz-Ok30aDX8JYmIP1_7-B1eQnmGaA51P-HrhNYB1mGNQG8XnRJ4g_ISxW8ZJQZoTx8sSK_BNmMgf8l5ttHYWyaAHcvoYamNM/s1600-h/DSC01237.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3mbvwJOXFWzHF5vcWFqvE0ErFdPhPYh_9kwxsAT9aQplxz-Ok30aDX8JYmIP1_7-B1eQnmGaA51P-HrhNYB1mGNQG8XnRJ4g_ISxW8ZJQZoTx8sSK_BNmMgf8l5ttHYWyaAHcvoYamNM/s400/DSC01237.JPG" alt="" id="BLOGGER_PHOTO_ID_5029439764505610370" border="0" /></a>62 year old man presented to us in 2003 with the above lesions over his left lateral thigh region of nine years duration.<br /><br />(The hyperpigmented areas are actually healed, photo taken 4 years after started on treatment).<br /><br />The HPE was reported as:<br /><span style="color: rgb(51, 255, 51);">Section shows skin tissue with central, irregular, benign, stratified squamous epithelial layer exhibiting acantholysis and mild pseudoepitheliomatous hyperplasia. The upper dermis shows presence of scattered, suppurative granulomas with neutrophils, multinucleated giant cells and ingested, pigmented "chest nut brown" rounded refractile fungal bodies. In addition, the dermis shows presence of numerous lymphocytes and plasma cells. Intrepretation: Chromoblastomycosis</span>.<br /><br />We repeated our own specimen and our HPE was reported as:<br /><span style="color: rgb(102, 255, 255);">Section showing mild hyperplasia of squamous epithelium with foci of granulomatous inflammation in the superficial dermis. Scattered multinucleated cells are seen. The dermis is infiltrated by neutrophils and lymphoplasma cells. No fungal bodies identified in this specimen. Interpretation: Chronic granulomatous inflammation, consistent with fungal infection</span>.<br /><br />He was started on C. Itraconazole 200 mg OD till now. The lesion has improved more than 50%.<br />The question is, how long should we continue with the anti-fungal treatment?<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com14tag:blogger.com,1999:blog-5825401141329982309.post-27530917625684157882007-02-07T11:40:00.000+08:002007-02-07T11:45:07.728+08:00Papular eczema<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgybkcvBc28OWuy4WovgzWM769yf3wQG_Z-mIB2OYEb3GRO2i5tg101hCtcxsgnnQb5X5tz6OUkeRjco4yA5ejqzWZ063GGVy1xQzDQaEdkfyA1N5z-Lf_qPZDM48ouUSOAOd7eHKSTzPA/s1600-h/DSC01206.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgybkcvBc28OWuy4WovgzWM769yf3wQG_Z-mIB2OYEb3GRO2i5tg101hCtcxsgnnQb5X5tz6OUkeRjco4yA5ejqzWZ063GGVy1xQzDQaEdkfyA1N5z-Lf_qPZDM48ouUSOAOd7eHKSTzPA/s400/DSC01206.JPG" alt="" id="BLOGGER_PHOTO_ID_5028632374061914450" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRJVd3oozH1RkKXmthv9YVoxl18sbeEgll9aEuH3hx_VJz_L3Fz8DAO2TM-qATZxtCuvRI6rf-nZQnA8fkVI4xT6ln86W9pyII1l3VQcqaDp8nBNdFDivZP6Iah4bTnIiveYDEZHkzR0w/s1600-h/DSC01207.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRJVd3oozH1RkKXmthv9YVoxl18sbeEgll9aEuH3hx_VJz_L3Fz8DAO2TM-qATZxtCuvRI6rf-nZQnA8fkVI4xT6ln86W9pyII1l3VQcqaDp8nBNdFDivZP6Iah4bTnIiveYDEZHkzR0w/s400/DSC01207.JPG" alt="" id="BLOGGER_PHOTO_ID_5028632262392764738" border="0" /></a>8 years old girl presented with the above very pruritic papules over her forearm and hands of 5 years duration. She was very embarrassed and depressed because her classmates made fun of her and refused to befriend her.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com114tag:blogger.com,1999:blog-5825401141329982309.post-7707465314830253552007-02-07T11:31:00.000+08:002007-02-07T12:15:14.098+08:00Derm round 12<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnnj4l6gNUOkU7uvwfOXeVfKvfmlffghYLZrNkpQYt8o0-UrT8RtC8v4MiMBdjHOwukHJpBacdklTcFkgVijsPHqkLUzv8hVa8Xu8MVGlzr7wTWzoCnL_nNdq2Ds54MxXc4S3Wu16UZG4/s1600-h/DSC01223.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnnj4l6gNUOkU7uvwfOXeVfKvfmlffghYLZrNkpQYt8o0-UrT8RtC8v4MiMBdjHOwukHJpBacdklTcFkgVijsPHqkLUzv8hVa8Xu8MVGlzr7wTWzoCnL_nNdq2Ds54MxXc4S3Wu16UZG4/s400/DSC01223.JPG" alt="" id="BLOGGER_PHOTO_ID_5028630222283299122" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvP38MhtZHZt-qTD21iRsgSBMrnlq2x8qU05qgnyinEAjF2tLkTtVvi_9FatDeVSb7D1CXiOlSAwMTdlJlcrrGixPz3j_tU_8ys9HmAR6xppYQkI4cHKXVqWRLh06MmRZIgMmjPs1gG1Q/s1600-h/DSC01225.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvP38MhtZHZt-qTD21iRsgSBMrnlq2x8qU05qgnyinEAjF2tLkTtVvi_9FatDeVSb7D1CXiOlSAwMTdlJlcrrGixPz3j_tU_8ys9HmAR6xppYQkI4cHKXVqWRLh06MmRZIgMmjPs1gG1Q/s400/DSC01225.JPG" alt="" id="BLOGGER_PHOTO_ID_5028629964585261346" border="0" /></a>30 years old man presented with the above lesions over the supra-pubic/base of penis since the age of 18 years old (12 years). He denied history of sexual exposure when he first had the lesions.<br /></div><br />These lesions looked something like this <a href="http://cytoderm.blogspot.com/2007/02/derm-round-8.html" target="_blank"">one</a> too.<br /><br />What is the diagnosis?<br />?Viral wart.<br /><br />Below, I included some <a href="http://www.emedicine.com/emerg/topic640.htm" target="_blank"">viral wart</a> pictures from DermNet.com:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6eg86dxa2AFPEJO7EVrDPhxzd1CW0PlTAwQ5n7IUfiS-xxFdTzkoUKY9yNaCbyERV5wITPnVQ-XWZoLFuOsXCdCTzQbDtZ9V47N10b0uVMex8Tuq3kV-5FAbrzx2q6T0tvvgdNSnuiBk/s1600-h/Wart1.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6eg86dxa2AFPEJO7EVrDPhxzd1CW0PlTAwQ5n7IUfiS-xxFdTzkoUKY9yNaCbyERV5wITPnVQ-XWZoLFuOsXCdCTzQbDtZ9V47N10b0uVMex8Tuq3kV-5FAbrzx2q6T0tvvgdNSnuiBk/s400/Wart1.jpg" alt="" id="BLOGGER_PHOTO_ID_5028639924614420978" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfC8eg_nOoE_icW1XkicbEi7i2IMZl_FwzgQHMTcdwd1ssU30oI8HHY0Gg4dFthgevZVD6GLNZ6E6tp74J7ADZQwr4T1ta0iQK51SRp3JeAlCH9PGfNCllLIlGrF-6glJayK9SQWCiC0U/s1600-h/Wart2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfC8eg_nOoE_icW1XkicbEi7i2IMZl_FwzgQHMTcdwd1ssU30oI8HHY0Gg4dFthgevZVD6GLNZ6E6tp74J7ADZQwr4T1ta0iQK51SRp3JeAlCH9PGfNCllLIlGrF-6glJayK9SQWCiC0U/s400/Wart2.jpg" alt="" id="BLOGGER_PHOTO_ID_5028639800060369378" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSVMHJxma3f3UIKoFruw8L5J0ttBtUjj9F05bghnVVsgEJvSmU1Xlrt5YpThCLfOD4QoqvBOmMN7dd84QnxoAlmiCdJLMuIKu6FDFO1-uYff5Luv7WctHIn6lY8WK0UfqNg3Z9ydK17sw/s1600-h/Wart3.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSVMHJxma3f3UIKoFruw8L5J0ttBtUjj9F05bghnVVsgEJvSmU1Xlrt5YpThCLfOD4QoqvBOmMN7dd84QnxoAlmiCdJLMuIKu6FDFO1-uYff5Luv7WctHIn6lY8WK0UfqNg3Z9ydK17sw/s400/Wart3.jpg" alt="" id="BLOGGER_PHOTO_ID_5028639688391219666" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxGWtRUnStWQCT88JzoWH7vM4cPsJdNQbAL0S-EgDQV6AYSZs5f9qG7L6eKrPAFHffsrlkZTmuoCxV6JvBbv5kQ2Y6KrBEsa62e5YO679dvOq_9jhbQm13HRd2l12bxMsoNtiXjm7sZ6E/s1600-h/Wart4.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxGWtRUnStWQCT88JzoWH7vM4cPsJdNQbAL0S-EgDQV6AYSZs5f9qG7L6eKrPAFHffsrlkZTmuoCxV6JvBbv5kQ2Y6KrBEsa62e5YO679dvOq_9jhbQm13HRd2l12bxMsoNtiXjm7sZ6E/s400/Wart4.jpg" alt="" id="BLOGGER_PHOTO_ID_5028639490822724034" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYj8priGfPJNB1tgW34EI7vg5myz1pEjKdGhSqlGxA_7oFUb72yrsLAn9H5K9Hh8A1M-ApmDTYDUfsHo9ZHOxDPZbID89gAvvlbWGpFzpipm3DOEWoZVEvvgYY58rwYI2-rfCbXsAPmek/s1600-h/Wart5.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYj8priGfPJNB1tgW34EI7vg5myz1pEjKdGhSqlGxA_7oFUb72yrsLAn9H5K9Hh8A1M-ApmDTYDUfsHo9ZHOxDPZbID89gAvvlbWGpFzpipm3DOEWoZVEvvgYY58rwYI2-rfCbXsAPmek/s400/Wart5.jpg" alt="" id="BLOGGER_PHOTO_ID_5028639104275667378" border="0" /></a>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com2tag:blogger.com,1999:blog-5825401141329982309.post-22645752774626648312007-02-06T22:42:00.000+08:002007-02-06T22:57:09.486+08:00Derm round 11<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSQPItxhhEX6oGjp-IM5CcYa-QjuFvO6RYE3VOOvNdUeMGTB81Ou77b9Nn6kT6DAS6Rshcfn0lT1tAU25x-orSAmE2C_dmgMtUtYgl7110jSYmKjCMHjxzV-Z__4Um9Zw8wgZuE44UauY/s1600-h/DSC01095.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSQPItxhhEX6oGjp-IM5CcYa-QjuFvO6RYE3VOOvNdUeMGTB81Ou77b9Nn6kT6DAS6Rshcfn0lT1tAU25x-orSAmE2C_dmgMtUtYgl7110jSYmKjCMHjxzV-Z__4Um9Zw8wgZuE44UauY/s400/DSC01095.JPG" alt="" id="BLOGGER_PHOTO_ID_5028432048197294354" border="0" /></a>65 years old lady presented with the above lesions over the face of 6 months duration.<br /><br />What are these lesions?<br />? <a href="http://www.emedicine.com/derm/topic170.htm" target="_blank">Granuloma faciale</a>.<br /><br /><div style="text-align: justify;">We did a biopsy and the result came back as such:<br />" <span style="font-style: italic;"><span style="color: rgb(255, 255, 0);">Multiple sections showed skin tissue with marked granulomatous lesion in the dermis consists of aggregates of epitheliod cells, lymphocytes and some multinucleated giant cells. No obvious central caseous necrosis seen. No atypical cell seen. No evidence of malignancy seen. Stains for fungal, AFB and leprae bacilli are negative</span>. Diagnosis: <span style="color: rgb(255, 0, 0);">Chronic granulomatous lesion, suggestive of atypical mycobacterial infection</span></span>."<br /><br />Hmn, rather non-specific isn't is?<br />What features actually point to atypical mycobacterial infection, huh?<br />Anyway, we will discuss the case in the HPE discussion session with the pathologists cm.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-75662164179730120392007-02-03T12:57:00.000+08:002007-02-03T13:15:00.561+08:00Derm round 10<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjskhE2yB1wFx1KZW_vJX6NSuoQHPeCvevsHwbLsvFIktXlJk7tFZoXIJokXEEjNgVNmnGoQYh_E-hkCxpd799Qy6q9gpHEBPGVEWgv_Ykw4pETqY1xToJC3KjmdUkow2Wd067pyZmqZ9M/s1600-h/DSC01168.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjskhE2yB1wFx1KZW_vJX6NSuoQHPeCvevsHwbLsvFIktXlJk7tFZoXIJokXEEjNgVNmnGoQYh_E-hkCxpd799Qy6q9gpHEBPGVEWgv_Ykw4pETqY1xToJC3KjmdUkow2Wd067pyZmqZ9M/s400/DSC01168.JPG" alt="" id="BLOGGER_PHOTO_ID_5027168842480965890" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAV3R2r9W4CLWE4TAnr_spyHtMQmEwkfNnMZe2D0nKhNbzEqqjzHDvHfuHZO2w9X-y57B93v-ZoXcIZT_BsPyHqXwzIAiWieIjj7jg1zHTQRk8IV-fJ8UgP8B-t26HJeBQHGYjabK3omQ/s1600-h/DSC01167.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAV3R2r9W4CLWE4TAnr_spyHtMQmEwkfNnMZe2D0nKhNbzEqqjzHDvHfuHZO2w9X-y57B93v-ZoXcIZT_BsPyHqXwzIAiWieIjj7jg1zHTQRk8IV-fJ8UgP8B-t26HJeBQHGYjabK3omQ/s400/DSC01167.JPG" alt="" id="BLOGGER_PHOTO_ID_5027168026437179634" border="0" /></a>The same lady with ?deep fungal infection (<a href="http://cytoderm.blogspot.com/2007/01/derm-round-4.html" target=_blank">Derm round 4, case 2</a>), was discharged and followed up in the clinic. The initial swab C&S grew <span style="font-style: italic;">Staphylococcus aureus</span> (<span style="font-size:85%;">Sensitive to Cloxacillin</span>). She was treated earlier with IV Unasyn and Metronidazole for one week. She had also been given two weeks of oral Cloxacillin.<br /><br />Currently, the lesions appeared to have dried up, but her left foot was still edematous. There were thick scale-like lesions on her left foot, which bled on removal of the scales.<br /><br />Still unsure what this lesions were due to. I was comtemplating to do a skin biopsy next.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-72566274055799475532007-02-03T12:40:00.000+08:002007-02-03T12:46:22.673+08:00Derm round 9<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJk5NJXrSW-oQFYdn7QHGn8bWCCT5K9hYbYDodwzYwYZdNuCNF2joXJ58543ILqWyyoNsgoXkXsjFDythG9bGTkUMI6wW6XUNhU73A8iS9Lc_Vq0kKrW1-PtA4TKYvSEhb22qOkt90iLs/s1600-h/DSC01176.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJk5NJXrSW-oQFYdn7QHGn8bWCCT5K9hYbYDodwzYwYZdNuCNF2joXJ58543ILqWyyoNsgoXkXsjFDythG9bGTkUMI6wW6XUNhU73A8iS9Lc_Vq0kKrW1-PtA4TKYvSEhb22qOkt90iLs/s400/DSC01176.JPG" alt="" id="BLOGGER_PHOTO_ID_5027163460886943970" border="0" /></a>20 years old gentleman presented with the above slightly painful, pruritic and smelly lesions over the the soles of three days duration. He is a kitchen helper.<br />Fungal scrapping was negative.<br /><br />What is it?<br /><br />? Pitted keratolysis as well.<br />I gave him a course of oral Erythromycin, KMNO4 soak and anti-fungal cream.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0tag:blogger.com,1999:blog-5825401141329982309.post-62749360906895682612007-02-03T12:26:00.000+08:002007-02-03T12:37:16.289+08:00Fixed drug reaction<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwcHUXvGNcgv6cRt79pXyxJsZuZzcubOIMy06oCdKel-U1DMjpPVKHl_7cUqczc-ZNHFBwhkAyfdCC6rclihQaDKmvgIRmrDz1Bf3h0sF-xP8a9kzw37qulfM0qKEbT0ZXK7RDyr4YSvY/s1600-h/DSC01177.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwcHUXvGNcgv6cRt79pXyxJsZuZzcubOIMy06oCdKel-U1DMjpPVKHl_7cUqczc-ZNHFBwhkAyfdCC6rclihQaDKmvgIRmrDz1Bf3h0sF-xP8a9kzw37qulfM0qKEbT0ZXK7RDyr4YSvY/s400/DSC01177.JPG" alt="" id="BLOGGER_PHOTO_ID_5027159861704349906" border="0" /></a>This gentleman developed the aboved lesions within 12 hours of taking Paracetamol for high grade fever. Review of his case notes, actually documented that he had history of allergic to Paracetamol. According to the patient, he felt terrible because of the fever and took the medication despite the known allergy.<br /><br />What other alternative if the patient has allergy to Paracetamol?<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com1tag:blogger.com,1999:blog-5825401141329982309.post-19048321064701036612007-02-03T12:19:00.000+08:002007-02-04T18:28:10.237+08:00Derm round 8<div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg63Kf0TQQ0kke282owSQ916-PP9TsQ4K1fbmWkZ0k_mNXCm5ZwdigrVmm60L_dZbaLQADU4gHBoHAX_UiDnNQAktbh5LrcEfUc6EZtjRDsQ43qOziMyVMwM_Spf2G26WPZbFE_AsgU3Xo/s1600-h/DSC01180.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg63Kf0TQQ0kke282owSQ916-PP9TsQ4K1fbmWkZ0k_mNXCm5ZwdigrVmm60L_dZbaLQADU4gHBoHAX_UiDnNQAktbh5LrcEfUc6EZtjRDsQ43qOziMyVMwM_Spf2G26WPZbFE_AsgU3Xo/s400/DSC01180.JPG" alt="" id="BLOGGER_PHOTO_ID_5027158410005403842" border="0" /></a>25 years old lady presented with the above lesions over the posterior neck region of 5 years duration.<br /><br />The lesions appeared warty or cauliflower-like.<br /><br />What is it?<br /><br />?Viral wart.<br />?Epidermal naevus.<br /></div>Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com2tag:blogger.com,1999:blog-5825401141329982309.post-68059982713078144872007-01-30T00:11:00.000+08:002007-01-30T00:19:55.627+08:00Lichen amyloidosus<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWOkM4YE0XiODC3K609OpRINqS8viLqLUuXHz6tydk-Gl6QZ9-nkgeSOxBQ1QcFWb7IBNEq5sffqDhnsz0stmC8pMlPNwMT7v8wnAU0vUbGRIfmbvUMRoKrssPGf8zKnOd-IAwcv96zd8/s1600-h/DSC01163.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWOkM4YE0XiODC3K609OpRINqS8viLqLUuXHz6tydk-Gl6QZ9-nkgeSOxBQ1QcFWb7IBNEq5sffqDhnsz0stmC8pMlPNwMT7v8wnAU0vUbGRIfmbvUMRoKrssPGf8zKnOd-IAwcv96zd8/s400/DSC01163.JPG" alt="" id="BLOGGER_PHOTO_ID_5025487297952265234" border="0" /></a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2Qv0hnH2xr1Yq8X9aMzobqpGfEhOEZrBQFndB7Pid0J4piBmng7NlrSXpIUadMKBx0MbGjDKsQJkoJiw5ZqEcXYMidfeJNalvO3Qc_PqlnKCbFImp8GK2gbddh7bl0G8_NompHsU9-aM/s1600-h/DSC01164.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2Qv0hnH2xr1Yq8X9aMzobqpGfEhOEZrBQFndB7Pid0J4piBmng7NlrSXpIUadMKBx0MbGjDKsQJkoJiw5ZqEcXYMidfeJNalvO3Qc_PqlnKCbFImp8GK2gbddh7bl0G8_NompHsU9-aM/s400/DSC01164.JPG" alt="" id="BLOGGER_PHOTO_ID_5025487289362330626" border="0" /></a>78 years old man presented with the above pruritic rashes of 6 months duration.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com3tag:blogger.com,1999:blog-5825401141329982309.post-66759694229788430952007-01-29T23:30:00.000+08:002007-01-30T00:05:52.725+08:00Dermatoses of PregnancyHere are two cases of pruritic lesions in pregnant patients:<br /><br /><span style="font-size:180%;"><span style="font-weight: bold;">Case 1</span></span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsgyMPhaCVaVULGLfBtnDhcPVVLganyvcP6TxP1QM-psMOZfYLOvpCMNbms_g1UGkuw9D3ep5u6q1b0F968X0f5Uz9yRGYwjqsX2cu7B8qlm0gTCvLo_R5niPS6Z5Y-mF1KWt1fdXj5zo/s1600-h/DSC01175.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsgyMPhaCVaVULGLfBtnDhcPVVLganyvcP6TxP1QM-psMOZfYLOvpCMNbms_g1UGkuw9D3ep5u6q1b0F968X0f5Uz9yRGYwjqsX2cu7B8qlm0gTCvLo_R5niPS6Z5Y-mF1KWt1fdXj5zo/s400/DSC01175.JPG" alt="" id="BLOGGER_PHOTO_ID_5025480430299558898" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0tFqAKjJKBZUcGw3f_UNQFDxctAwpmmwzvGJmFj5RJxXL2bmZl-A3M5M6Z6c9RDenRRcXhdElBSVfF9xHOGibcP2Fl0TtHLusWSeS3MzHY9ppxl2g1b5lVKfNSloEHkEtIFK1rw24Sf4/s1600-h/DSC01173.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0tFqAKjJKBZUcGw3f_UNQFDxctAwpmmwzvGJmFj5RJxXL2bmZl-A3M5M6Z6c9RDenRRcXhdElBSVfF9xHOGibcP2Fl0TtHLusWSeS3MzHY9ppxl2g1b5lVKfNSloEHkEtIFK1rw24Sf4/s400/DSC01173.JPG" alt="" id="BLOGGER_PHOTO_ID_5025479979327992802" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMX4UoWR8c6etebzFLy6bbrVNOSl-8FR6l2lwGJ6kTdq0GljRQ9q6CkhBQ2w6LMMuoa5fG4etWTUVpEKyFVSvJki5A7N_Y25Be07aUovOBnVlifmeN0-vjsoqrLwhmGiZE8BJU2SkQn7c/s1600-h/DSC01172.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMX4UoWR8c6etebzFLy6bbrVNOSl-8FR6l2lwGJ6kTdq0GljRQ9q6CkhBQ2w6LMMuoa5fG4etWTUVpEKyFVSvJki5A7N_Y25Be07aUovOBnVlifmeN0-vjsoqrLwhmGiZE8BJU2SkQn7c/s400/DSC01172.JPG" alt="" id="BLOGGER_PHOTO_ID_5025479463931917266" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4DTC-wZF-vZ-UyF5gRjkPIgVeJs619t5jTLVXSdFlQjnHXTluecRwjpjlsV98DFm_moNGlB6kFqwsqVuprRmSiSis4dVJXU9uilLwCt7MfrWAD2awWMiiw3-ccPPFqDMdWw1QBWhq7vE/s1600-h/DSC01171.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4DTC-wZF-vZ-UyF5gRjkPIgVeJs619t5jTLVXSdFlQjnHXTluecRwjpjlsV98DFm_moNGlB6kFqwsqVuprRmSiSis4dVJXU9uilLwCt7MfrWAD2awWMiiw3-ccPPFqDMdWw1QBWhq7vE/s400/DSC01171.JPG" alt="" id="BLOGGER_PHOTO_ID_5025478991485514690" border="0" /></a>26 years old G1P0 at 27 weeks of POA, presented with the above pruritic papules and nodules over her abdomen, upper and lower limbs. She claimed the lesions were drier 2 days post-partum.<br /></div><br /><br /><span style="font-size:180%;"><span style="font-weight: bold;">Case 2</span></span><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhMFiQ_Ij7lXfXX_tnavXiPIcYZIBelfMUhqZMN_CCMt_YjnMlXogM5nLQvzq5PbOE0_ZnO7j5Zx5QLFeyHqJ08193s7sKR1dhWiYxHuFNXqSjRATTpwV-su2jJuYGFY_l6FeZfVc7Yk8/s1600-h/DSC01139.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhMFiQ_Ij7lXfXX_tnavXiPIcYZIBelfMUhqZMN_CCMt_YjnMlXogM5nLQvzq5PbOE0_ZnO7j5Zx5QLFeyHqJ08193s7sKR1dhWiYxHuFNXqSjRATTpwV-su2jJuYGFY_l6FeZfVc7Yk8/s400/DSC01139.JPG" alt="" id="BLOGGER_PHOTO_ID_5025477359397942194" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxhUBBeGAvLzxL3WYg_gQxlGkiTRhxoN2UDlycXG1Ul64dtESsfb2uusxzKCy3f7HAe8gJY3WMCnAV1sZfmqPiBTi7jc1DKhJBsbVpgDEol25lJJKbsc0MnUsvwBHvh0yWIwlYAnWgoQw/s1600-h/DSC01140.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxhUBBeGAvLzxL3WYg_gQxlGkiTRhxoN2UDlycXG1Ul64dtESsfb2uusxzKCy3f7HAe8gJY3WMCnAV1sZfmqPiBTi7jc1DKhJBsbVpgDEol25lJJKbsc0MnUsvwBHvh0yWIwlYAnWgoQw/s400/DSC01140.JPG" alt="" id="BLOGGER_PHOTO_ID_5025476805347160994" border="0" /></a><br /><div style="text-align: justify;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm39bFIG_ZnnWAG9LmgpGSfW5p5MGLY4VPbrztxE38CKgDXekrvo_Q3bdl3FZHFxsKkuWDsTgHrRWxLcAAUR-RtyyEPUCg2QtJscwMTJlmzSaXPLpj_jGb_RudBU-WULYVPTNL4pwmGig/s1600-h/DSC01141.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm39bFIG_ZnnWAG9LmgpGSfW5p5MGLY4VPbrztxE38CKgDXekrvo_Q3bdl3FZHFxsKkuWDsTgHrRWxLcAAUR-RtyyEPUCg2QtJscwMTJlmzSaXPLpj_jGb_RudBU-WULYVPTNL4pwmGig/s400/DSC01141.JPG" alt="" id="BLOGGER_PHOTO_ID_5025476281361150866" border="0" /></a>25 years old G1 P0 at 12 week of POA, presented with the above pruritic papules over the upper and lower limbs of three weeks duration.<br /></div><br />What is it among the 6 types of dermatoses of pregnancy?<br />Prurigo of pregnancy.<br /><br />Related case in <a href="http://dermdoc.blogspot.com/2007/01/blog-round-1.html" target="_blank"">Derm round 1</a>.Cytodermhttp://www.blogger.com/profile/16050548163376269512noreply@blogger.com0