Usually psoriasis presents as bilateral symmetrical fiery-red or salmon pink well-demarcated plaques covered with large thick white silvery scales. However, occasionally some of these features may be missed as in this 32-year-old male who presented with unilateral leg involvement but all other characteristic features are well seen.
All posts by Nameer Al-Sudany
Varicella
A 14-year-old boy presented with fever, malaise, and myalgia followed one day later by sudden eruption of generalized rash involving mainly the face and trunk. O/E, polymorphous rash with many vesicular lesions on red base assuming an appearance of “dew drops on rose petals) the characteristic of chicken pox. Varicella occurring in late childhood or adulthood may present with more severe prodromal symptoms and rash.
Nummular eczema
A 4-year male toddler with positive personal and family history of atopic dermatitis presented with somehow demarcated severely pruritic red scaly plaque with few fine fissures on the top of right foot of 3 weeks duration in addition to generalized mildly xerotic skin. KOH wet mount preparation for dermatophytes was negative. No significant response to two weeks topically applied Tacrolimus ointment but adding topical betamethasone valerate ointment later has resulted in very good improvement. Discoid eczema in children may present de novo or may be part of atopic dermatitis.
Androgenic alopecia
A 26-year-old male with strong family history of common baldness presented with hair loss involved most of the crown area of one year duration. A 1 mg finstaride orally p;us topical 5% minoxidil solution twice daily have been prescribed waiting the results.
Striae distesae
There are 4 causes of striae distensae:
1. Pregnancy (Stria gravidarum)
2. Obesity (Over-stretched skin)
3. Steroid induced: A. Cushing’s syndrome: Endogenous steroids excess
B. Corticosteroids (Systemic and/or topical) and sex steroid hormones : Exogenous steroids excess
4. Heavy-weight lifters (Sport): due to large muscle mass stretching the overlying skin and Occasionally there may be an additional role for anabolic steroids.
Predilection sites: generally skin overlying fat cushions (abdomen, buttocks, thighs, calf region, shoulders, over the biceps muscle and occasionally the back). Skin overlying bony areas seems to be exempted.
The presented case is a 24-year-old female presented with purplish linear atrophic areas involved many predilection sites but maximally over the calves (Photo) due to misused corticosteroids for 2 months to increase body weight.
N.B: Striae usually have purplish color in early stages (first few months) but later became narrower and whitish in color.
Plaque psoriasis
Very well-demarcated, large, oval, red plaque covered with silvery scales involved the lower part of the shin of one year duration. Many other similar but smaller plaques were seen on other parts of the body even on the scalp.
Trichotillomania
A teenager girl presented with non-cicatricial alopecia involving large area of the scalp of 4 months duration. The patient’s mother hadn’t noticed a habit of hair pulling by her daughter while the patient her self admitted positive habit specially under psychological tension. The diagnostic feature on examination was that the hairs were cut at different levels of the scalp surface.
Mucocele
An 18-year-old male presented with an asymptomatic, translucent, dome-shaped cyst about 1.5 cm in diameter involved the mucosal side of the lower lip of many months duration. It has been excised and primarily sutured under LA.