Dermatology Oasis

Editor: Dr. Nameer Al-Sudany (IRAQ)

Oral fibroma

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A few months after accidental self’s lip bite, an asymptomatic, small, oval, smooth-surfaced, pale pink nodule arouse from the buccal surface of the lower lip. It was removed by electrocautery under local anesthesia.

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Napkin’s candidiasis

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A 6-month-old female infant presented with red glazed rash involved the groin area including the inguinal flexures. It started as as napkin irritant contact dermatitis with superimposed candidiasis of one month duration. The rash is well-demarcated erythemtous with peripheral scales and many characteristic satellite papules and pustules. KOH smear yielded short wide hyphae and budding candidal cells Nustatin cream plus Hydrocortisone 2.5% cream applied twice daily for 2 weeks have cured the rash.

 

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Oral lichen planus

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The dorsal surface of the tongue is smooth, glistening and whitish with few surface fissures. Other parts of the oral cavity are normal. Skin, hair and nails were negative. VDRL and TPHA were non-reactive. Great relief from pain on eating and even on talking on intralesional triamcenolne infiltration (5 mg per ml) given every 3-4 months. Topical CS in orabase was not effective.

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Pigmented nodulo-ulcerative BCC

Pigmented nodulo-ulcerative BCC
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An asymptomatic, rounded, well-circumscribed, pigmentd nodulo-ulcerative lesion about 2 centimeters in diameter with rolled-up border of more than one year duration. The tumor had been removed with a suitable safe margin.

 

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Psoriasis

Psoriasis
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A 30-year-old male presented with asymtomatic, well-marginated, red scaly plaques involved the upper inner thighs and hands of many years duration. The plaques on the hands produced keratoderma with fissuring of the palms. Most topical anti-psoriatic therapies failed to produce significant improvement. Shifting the patient to Acitretin 25 mg per day yielded excellent response in thigh lesions and satisfactory improvement of palmar lesions.

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Phototoxic dermatitis

Phototoxic dermatitis
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A 38-year- old woman with burning-painful unilateral rash on one shin of 3 days duration. The patient suffered vitiligo on lower legs of many months duration. She had been treated with topical trisoralen solution plus sun light exposure at day time and combined mometasone furoate and tacrolimus in ointment base at night. One day after commecement of treatment she developed a localized but severe bullous rash confined strictly to the vitiliginous area on which the solution had been applied. This phototoxic (irritant contact) dermatitis reaction is commonly encountered in daily practice even sometimes with many folds dilution of trisoralen solution.

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Bowen’s disease

Bowen’s disease
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An 80-year-old man presented with an asymptomatic, solitary plaque with well-demarcated border on the chest of about 3 years duration. O/E: a superficial erosion was seen.  Two clinical differential diagnoses were in mind; BCC and Bowen disease. Incisional biopsy showed Bowen’s disease with early invading SCC.

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Median nail dystrophy

Median nail dystrophy
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Some nervous habits damage the nails and some people may bite or pick up their cuticles and the skin around the nails. In the common habit tic nail dystrophy, the cuticle of the thumbnail is the target for picking or rubbing. This repetitive trauma causes a ladder pattern of transverse ridges and grooves to run up the center of the nail plate. A 15-year-old boy presented with bilateral thumbnails medial dystrophy due to nail cuticle and plate picking of three years duration.

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