Derm round 4

Case 1

24 years old lady, G1P0 at 15 week of POA was found to be anaemic (Hb 7.8gm/dl) during routine blood check and was admitted for further management. Further history, she complained of red facial rashes started since she was found pregnant. She also complained of mild on and off arthralgia. The was no alopecia, oral ulcer or proximal myopathy. Her TWBC was low (3.4) and her ESR was also high (78 mm). Clinically, she has erythematous facial rashes in distribution suggestive of possible photodermatitis (pic not shown). The above was the appearance of her hands, which showed periungual erythema. We are currently working her up for connective tissue disease.

Case 2

78 years old lady, with no previous medical illness, presented with the above nodular and hyperpigmented lesions over her lower limbs of 10 months duration. Note that, there were some healed hyperpigmented scars. Currently, she presented with worsening lesions with pain, ulceration and pus discharge. We thought it might be some deep fungal infection (?Acinomycetoma)

Case 3

The above 78 years old man, with previous history of IHD/DM/HPT/Dyslipidaemia/old stroke, presented with the above pruritic body lesions of one month duration. The lesion over the right knee had been there for 6 months. There was also a previous surgical scar of right knee surgery.
The body and upper limbs lesions were well defined, hyperpigmented, dry and scaly. Scalp and nails were normal. Fungal scrapping was negative.
I am thinking of some form of discoid ezema; with some differentials of ?psoriasis/? CTCL.

Any comment regarding the above pictures?