Dermatology News

A healthy 14-year-old male presents with a rash on the sole of his left foot. He first noticed that there was something there 1 to 2 weeks earlier and that it was pruritic. There have been no other associated complaints, disturbing symptoms or fever. His past medical history is unremarkable, and his family history reveals no sick contacts or anyone else with skin or foot problems. His travel history, however, reveals that he spent 7 days at a tropical beach resort with his family. They had returned home about 1 week before the foot lesion was first noted.

A previously healthy 16-year-old male was admitted to the hospital with severe scrotal and penile swelling. The onset of the problem was 6 days earlier, beginning with only some pruritus. However, the next day, he noticed progressive swelling, and he informed his mother, who felt like it was nothing unusual and continued to watch. Two days later, however, the swelling and itching were significantly worse and he was taken to the ED. There, a fungal infection was diagnosed (“jock itch”) and he was given a prescription for fluconazole, along with topical antifungal cream. However, the next day, the swelling had reached a massive size and he returned to the ED, where an ultrasound of the scrotum was performed, ruling out testicular torsion or other intrascrotal abnormality, and he was diagnosed with cellulitis. He was given IV clindamycin plus nafcillin and referred for admission.

Depressive disorders and suicidal ideation accounted for 55.1% of all reported psychiatric adverse events among patients taking isotretinoin from 1997 to 2017, according to researchers in JAMA Dermatology. However, the rate of completed suicide among these patients may be not be higher than those reported in the general U.S. population.

An 11-year-old healthy female presented to the dermatology clinic for evaluation of a facial rash that had lasted for 3 weeks. Initially, it was a round, scaling papule treated by another provider with combination betamethasone dipropionate 0.05%/clotrimazole 1% cream, but the rash worsened. This was followed by mupirocin ointment, without improvement. She has since been using triamcinolone 0.025% ointment for the last 4 days and feels it is enlarging (Figure 1). It is not painful but is mildly itchy.

A 16-year-old male presented with a few fluid-filled lesions (vesicles) on his right popliteal area, accompanied by significant pruritus. As the patient continued scratching the area, new lesions continued to appear. After two visits to the primary’s office, two courses of oral antibiotics and one ED visit, he was admitted to the hospital for IV antibiotics for a presumed infection. The patient was previously healthy, with no underlying chronic or acute diseases, and he had no fever. He is a high school athlete, who was running track when this condition started. He spends a lot of time in the grass stretching prior to his track workouts. He denied any injury to the area, and did not recall any unusual insect bites. His exam was that of a healthy 16-year-old male, with the only abnormal finding being this unusual area of mild-to-moderate diffuse erythema, with some patches of lesions containing small pustules or vesicles, which initially appeared to resemble “kissing lesions,” as shown in Figure 1. Within a few days, these popliteal lesions progressed to more severe, fluid-filled lesions, with some drainage of serosanguinous fluid (Figure 2). The patient also had some discrete, smaller lesions appearing on various other parts of his body (Figures 3 and 4).

In scabies treatment, oral ivermectin at 200 µg/kg may be associated with slightly lower rates of complete clearance after 1 week compared with 5% permethrin cream, but researchers found little or no difference in complete clearance by weeks 2 and 4.

Researchers have identified a drug-free approach to treating MRSA using blue light and hydrogen peroxide.

A 6-year-old, previously healthy male, with no past skin disorders or infections, presents with an unusual, progressive cluster of pruritic lesions on the posterior thigh and popliteal areas of his right leg. The area has been damaged by persistent scratching due to the pruritus. The problem was thought to have started with numerous mosquito bites about 4 weeks earlier. The patient has been seen several times with a variety of anti-infective therapies prescribed, including topical mupirocin, oral trimethoprim-sulfamethoxazole, clindamycin, cephalexin, acyclovir and even one dose of intramuscular ceftriaxone, none of which seem to have had any impact on the lesions, which included early blistering, followed by some crusting, followed by raw, weeping erosions that ultimately dried up. It is likely that scratching may have significantly altered the course. The patient was never sick or febrile, and no other members of the family or close contacts have had similar problems.

A 7-year-old healthy male presented to the dermatology clinic for evaluation of a facial rash. The rash had been happening off and on over the last few years. It is most notable during the winter. He reported mild burning and itching at the site of the rash (Figure 1). His parents had tried multiple lip balms, shea butter and Aquaphor with varying levels of improvement. Coconut oil made it worse.

The rare occurrence of a scabies outbreak in the NICU of a children’s hospital underscored just how difficult the disease is to diagnose and treat in that setting, according to researchers.