Daniel Stulberg, MD

This newborn was noted to have these facial lesions at time of birth. On further exam there is some erythema on the nape of the neck. The parents indicate that the color seems to be more or less prominent at various times. The pregnancy and delivery were otherwise uncomplicated.

This 69-year-old woman requested evaluation of scaling behind her left ear, which has been present for 8 months after she started a new shampoo.

This 25-year-old African-American man has had this papular rash for the last 2 years following a short haircut. Initially he had pustules, itching and inflammation but currently only has itching papules that are slowly enlarging. Triamcinolone 0.1% ointment has helped the itching. Past history and remainder of physical examination is noncontributory.

This 29-year-old man came in for a wellness evaluation but notes having had this rash for 8 years. Occasionally it itches, but otherwise is asymptomatic and he has had no treatment for it to date. He does not take any medications and has no significant past medical history.

This 3-day-old boy was noted to have this left buttock lesion. He was born by cesarean section at 35 weeks due to a transverse lie on presentation with premature rupture of membranes. There was no prenatal care, and routine maternal labs on admission were significant for a positive gonorrhea screen.

This 8-year-old girl came down with this itching rash following a horseback ride and a soak in a whirlpool spa. Other than itching, she has no symptoms and is in good health with no significant past medical history or medications.

This 71-year-old woman presented with an itchy raised erythematous leg lesion that had been present for 10 months. She has a history of significant sun exposure in the past and was prescribed topical triamcinolone 4 months ago which she believes has made it slightly smaller and less itchy.

This newborn was found to have these fragile white lesions on the scrotum and extremities along with dark macules on the face. The child was otherwise asymptomatic and the pregnancy was uncomplicated, with no significant medication exposures and no family history of similar lesions.

This 70-year-old woman noticed a rash one week ago in her right lumbar area with mild pain and change in skin color.

This 23-year-old man developed these lesions on his feet during a 10-month stay in Nicaragua. Initially he had itching and burning. He has been treated with 3 courses of topical antifungal preparations and there is no significant past medical history other than sweaty feet.

This 70-year-old woman was referred for this waxing and waning erythematous facial rash of two years duration. She has tried topical metronidazole and clindamycin without improvement. Her past medical history is significant for hypertension and hypothyroidism, otherwise she is in good health and a review of systems is negative except for the itching facial rash.

This 28-year-old woman presented with a large hyperpigmented patch on the right side of her upper back. Although the lesion developed over the past 2 years, it has been "sinking in" over the past 2 weeks. The patient denies any trauma, pain, discomfort, or pruritis, as well as any family history of cancers, lymphoma, or autoimmune disease. However, she has a history of gastroesophageal reflux disease and onychomycosis, and her grandfather has a similar lesion.

This newborn infant was noted to have a congenital skin malformation on both sides of his face. However, the pregnancy was uncomplicated, he is feeding well, and no other abnormalities were seen on examination.

A 36-year-old pregnant woman at 27 weeks gestation presented to the obstetrical triage for evaluation of possible abscess due to a lesion on her buttock that first appeared 1 week ago. Since that time, it has become increasingly painful and itchy. Although she denies any systemic symptoms, her pregnancy is complicated by gestational diabetes and obesity. However, she is HIV negative and her other prenatal labs were unremarkable.

A 57-year-old man presented to clinic with this persistent skin lesion on his thumb. Three months ago, he lanced the lesion, producing some purulence and blood. Since then, it has bled almost daily and has not healed. He was treated with silver nitrate by another clinician after one month, but the lesion persists. His past medical history is significant for diabetes and his family history is significant for 2 cousins with melanoma.

A 58-year-old woman presented to clinic with concerns about this skin lesion on her upper chest. She reports it has been present for 1 year and is slowly enlarging. The lesion is otherwise asymptomatic and her past history is only significant for rheumatoid arthritis (RA), for which she takes methotrexate and etanercept.

A 59-year-old man presented to clinic with concerns that his ezetimibe prescription was causing an itchy rash. The rash first appeared on his hand 1 year ago and now it involves his arm, as well. The man's past medical history is significant for coronary artery disease, hypertension, hyperlipidemia, and hypothyroidism. He has tried a topical antifungal agent and oral fluconazole to no avail.

A 59-year-old woman presented to clinic for evaluation of multiple moles. Although the moles were not suspicious on physical exam, she was noted to have bilateral deformities of her thumb nails. Her past medical history is significant for chronic knee pain and breast cancer that was successfully treated 13 years ago. What is your diagnosis?

A 60-year-old gentleman presented to a clinic with a large ulceration over his left tibia. The wound was friable, erythematous, and purulent, with necrotic involvement of the tibial tendon sheath. He reports that the lesion started 15 years ago and worsened after surgical debridement 10 years ago. High-dose prednisone helped in the past, but other medications have been of no help. Recently, the patient developed intense pain with occasional fevers, chills, and night sweats. He has type 2 diabetes mellitus, but denies any history of bowel difficulties, hepatitis, or arthralgias. What is your diagnosis?

This 6-year-old boy presents to the ER with a 2-day history of increasing pain and swelling in his right ankle. On the day of his arrival, he also developed the rash pictured here. The patient denies any other symptoms aside from his ankle and knee pain. His chest X-ray, vital signs, complete blood count (CBC), and basic chemistry panel were normal, though urinalysis showed a trace of blood.

This 44-year-old man presented to a clinic with multiple dark lesions on his lower extremities. When the lesions first appeared eight months ago, they were slightly raised, pink in color, and intensely itchy, but after repeated excoriation, they have become increasingly dark. The patient reports that a biopsy was inconclusive and creams and an oral medication have not helped his condition. In addition to his leg lesions, there is some involvement of the thigh, buttocks, and penis. He denies any past medical history or other medications. What condition does this man have?