Acne keloidalis nuchae

Age: 26 years
Gender: male
Site: lower occipital scalp and upper neck
Duration: 3 years
History: cosmetic concern and mild pain
Findings: inflammatory papulonodules and scarring
Diagnosis: clinical
Treatment:
* Systemic antibiotics plus topical antibiotics and corticosteroids
* Intralesional corticosteroids

Tattoo granuloma

Age: 64 years
Gender: female
Site: forearm
Duration: two years
History: amateur tattoo was made 4 decades ago. Carbon (Soot) is the material (dye) of tattooing in this type of tattoo! Carbon is introduced into different levels (depths) within the dermisby pin pricking or needling!
Findings: asymptomatic granulomatous nodules at sites of previous tattoo (colored arrows)
Diagnosis: clinical
Treatment: intralesional triamcenolone acetonide 2.5-5 mg/ml.

Dermatitis artefacta

Age: 38 years
Gender: female
Site: flexor forearm
Duration: one month
History: the patient denied any self-mutilation
Findings:clear cur longitudinal ulcer about 12 x 2.5 cm with red border and yellowish brownish crustation
Diagnosis: depends on high suspicion index. Suspicion originated from:
* Regularity of the ulcer
* Rapid evolution
* Lack similarity to known ulcerative dermatoses
* Patient's denial of self inflection
* Non specific histologic findings on skin biopsy
It was suspected to be self induced with a caustic chemical material (chemical burn)!
Treatment:
* Reassurance and topical antibiotics to prevent secondary bacterial infection.
* Referral to a psychiatrist.

Irritant contact dermatitis

Age: 25 years
Gender: female
Site: lower face
Duration: 5 days
History:
* Severe burning sensation
* The reaction developed few hours after application of a topical combined preparation contains Retin A
Findings: red scaly rash
Diagnosis: Clinical
Treatment:
* Immediate withdrawal of the expected culprit
* Betamethasone valerate 0.1% ointment applied twice daily which gave excellent result within 10 days.

Unilateral ear psoriasis

Age: 6 years
Gender: female
Site: auricle (unilateral)
Duration: 6 months
History:
* Asymptomatic unilateral rash
* Negative family history of psoriasis
Findings: Typical psoriatic plaque confined to one ear only!
Diagnosis: clinical
Treatment: Topical corticosteroid with 1-2% salicylic acid

Bowen's disease complicated by SCC

Age: 75 years
Gender: female
Site: back
Duration: > 5 years
History:
* Russian woman living in IRAQ since many decades
* Asymptomatic red plaque
Findings:
* Giant red infiltrative well demarcated plaque
* Dome-shaped red nodule, about 1 cm in diameter, in the center of unknown duration! (see the black arrow)
Investigations: two biopsies were taken; first one from the plaque and second one was deep taking the entire nodule.
Results:
First biopsy showed Bowen's disease
Second biopsy revealed SCC reaching the lower dermis
Treatment: referred to the oncology department 

Cement contact dermatitis

Age: 24 years
Gender: male
Site: hands (palms)
Duration: 3 months
History:
* Contact with cement (works as a lumper)
* Severe itching
Findings: bilateral symmetricaldry scaly erythematous rash with fine fissuring
Diagnosis: Clinical
Treatment:
* Ultrapotent topical corticosteroids plus oral antihistamines
* Advised to change job or at least wear protective gloves

Orf

Age: 35 year
Gender: male
Site: left thumb
Duration: one week
History:
* Contact with sheep's meat
* Painful nodule
Findings: solitary nodule with targetoid appearance
Diagnosis: clinical
Treatment: symptomatic
Follow up: complete disappearance within 6 weeks

Isotretinoin-induced paronychia

Age: 20 years
Gender: male
Site: periungual
Duration: 2 months
History:
* Isotretinoin 40 mg per day for nodulocystic acne
* Painful swelling of proximal and lateral nail folds of many fingers
Findings: proximal and lateral paronychia
Diagnosis: clinical and confirmed by complete clearance of paronychia after stopping isotretinoin therapy.
Treatment: stopping isotrtinoin and symptomatic treatment with combined topical corticosteroid and antibiotic (Fucicort cream). 

Umbilical granuloma

Age: 14 days
Gender: male
Site: Umbilicus
Duration: 10 days
History: easily bleeding tendency (on minor touch)
Findings: a pinkish red nodule protruding from the umbilical stump
Diagnosis: clinical
Treatment: Successful cauterization with silver nitrate stick (two sessions three days apart)

Angiokeratoma of the scrotum

Age: 32 years
Gender: male
Site: scrotum
Duration: > 3 years
History: bleeding on hair shaving of the area
Findings: multiple small angiokeratomas
Diagnosis: clinical
Treatment: CO2 laser vaporization 

Erythema mutiforme

Age: 21 years
Gender: female
Site: hands
Duration: one week
History: No previous infection or relevant drug intake
Findings: bilateral symmetrical typical target lesions
Treatment: just reassurance 

Kerion

Age: 8 years
Gender: male
Site: scalp
Duration: 6 months
History: Slight pain and pus discharging
Findings:
* Boggy mass with many abscesses
* Scarring alopecia
Diagnosis: clinical
Treatment: Fluconazole orally given for three months was unsuccessful: shifting to Griseofulvin 20 mg per day gave good results. However, scarring alopecia couldn't be avoided!

Basisquamous cell carcinoma

Age: 82 years
Gender: male
Site: scalp
Duration: one year
History: Previous exposure for radiation therapy in 1950s for tinea capitis
Findings:
* An asymptomatic large ulcer with everted border arouse from previously treated site of non-melanocytic epidermal carcinoma (BCC or SCC?)
* Atrophic scalp
* Many pigmented BCCs
Investigations: skin biopsy
Treatment: Curettage and Cautery (three cycles)
Follow up: six months later with no evidence of clinical recurrence

Flexural lichen planus

Age: 40 years
Gender: male
Site: axillae
Duration: one year
History: an asymptomatic purplish hyperpigmentation
Findings: bilateral symmetrical slightly scaly purplish hypopigmented patches with fine Wickham’s striae
Diagnosis: Clinical
Treatment: Topical corticosteroid (Mometasone furoate) plus Calcineurin inhibitor (Pimecrolimus) creams.

Rosacea

 

Age: 45 years

Gender: Female

Site: Face

Duration: 3 years

History: Burning erythema

Findings: 

* Butterfly erythema

* Swelling

* Papules and pustules

Diagnosis: Clinical

Treatment: 

* Oral isotertinoin 10 mg once per day for 12 weeks (She had poor response to multicourses of systemic with or without topical antibiotics!