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Presentation The patient may have stepped on a nail or sustained any sort of laceration, abrasion, or puncture wound when the question of tetanus prophylaxis arises. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Presentation A possibly contagious animal has bitten the patient, or the animal’s saliva has contaminated an abrasion or mucous membrane. There may have only been a questionable exposure to a bat, but the nature of the contact (if there was any contact) is unknown. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a…

You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

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Presentation Patients generally seek medical care when a wart has become painful, partially avulsed, cosmetically unacceptable, or otherwise annoying. Common warts usually appear as one or more dome-shaped hyperkeratotic verrucous papules on the hands but may occur anywhere on the body. Plantar warts occur on the soles of the feet, interrupting the normal skin lines and frequently occurring at points of maximum pressure, such as over…

Presentation The patient is generally very uncomfortable with intense itching. There may be a history of similar episodes and perhaps a known precipitating agent (bee or fire ant sting, food, or drug). More often, the patient will have only a rash. Sometimes this is accompanied by nonpitting edematous swelling of the lips, face, hands, and/or genitalia (angioedema). In the more severe cases, patients may have associated…

Presentation The patient is troubled with an intensely pruritic rash that often consists of raised lesions that develop into vesicles and are usually formed in a streaked or linear pattern. Eventually there is a weeping, honey-colored crust, confluence of vesicles, and (sometimes) large bullae ( Fig. 184.1 ). If involvement is severe, there may be marked edema, particularly on the face, periorbital areas ( Fig. 184.2…

Presentation Patients usually seek medical care for athlete’s foot, jock itch, or ringworm when pruritus is severe or when secondary infection causes pain and swelling. Worrisome spreading of the rash, along with an unsightly and annoying appearance, will also motivate these patients to seek medical treatment. Tinea Pedis There are three general clinical presentations: interdigital, moccasin, and vesicobullous. Interdigital disease is most common. Often there is…

Presentation The patient arrives with a tick attached to the skin ( Fig. 182.1 ) and is often frightened or disgusted and concerned about developing Lyme disease, Rocky Mountain spotted fever (RMSF), or “tick fever.” Alternatively, the patient may only have a history of having removed a tick within the past week or so and now has developed a spreading erythematous rash at the previous site…

Presentation Patients generally seek help only if their sunburn is severe. There will be a history of extended exposure to sunlight or to an artificial source of ultraviolet radiation, such as a sunlamp. Patients at highest risk typically have fair skin, blue eyes, and red or blond hair. The burns will be accompanied by intense pain, and the patient will not be able to tolerate anything…

Presentation Patients seek help because of an intense pruritic or painful eruption of red raised welts, sometimes like mosquito bites. They are at times confluent, appearing in areas that had been covered by swimwear ( Fig. 180.1 ). This will occur within a few hours after bathing in the Caribbean or off the coasts of Mexico, Florida, or Long Island during periods when so-called sea lice…

Presentation Patients present for evaluation due to inability to sleep as a result of intense itching. Severe pruritus, which is the hallmark of this disease, is intensified at night for unclear reasons. These patients have skin lesions that include mite burrows, which appear as short (about 2–3 mm in length), elevated, gray, threadlike, serpiginous tracks. A small papule or vesicle may appear at the end of…

Presentation Often there is a history of a laceration or minor trauma to the skin or mucous membrane several days to a few weeks before presentation, but in most cases there is no apparent cause. The head, neck, and extremities are most commonly involved, especially the lips, oral mucosa, and fingers. An unsightly lesion forms, beginning as an extremely friable red or yellow papule or polyp,…