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,…

Presentation Patients with this rash often seek acute medical help because of the worrisome sudden spread of a rash that began with one local skin lesion. This “herald patch” may develop anywhere on the body, but it is typically on the trunk and appears as an ovoid, 2 to 6 cm in diameter, mildly erythematous and slightly raised scaling plaque with a collarette of scale at…

Presentation Patients arrive with emotions ranging from annoyance to sheer disgust at the discovery of an infestation with lice or crabs and request acute medical care. There may be extreme pruritus, and the patient may bring in a sample of the creature to show you. Head lice generally affect children aged 3 to 12 years. The adult forms of head lice ( Pediculus humanus capitis )…

Presentation Partial-thickness burns can occur in a variety of ways. Spilled or splattered hot water and grease are among the most common causes, along with hot objects, explosive fumes, and burning (volatile) liquids. The patient will complain of excruciating pain, and the burn will appear erythematous with vesicle formation. Some of these vesicles or bullae may have ruptured before the patient’s arrival, whereas others may not…

Presentation Parents will usually bring their children (most commonly aged 2–5 years, although it can occur in any age group) to be checked because they are developing unsightly skin lesions. The lesions are usually painless but may be pruritic and are found most often on the face ( Fig. 174.1 ) or other exposed areas. Parents may be worried that their young child has “infant-tigo,” the…

Presentation Sometimes a patient comes to a hospital emergency department (ED) or urgent care center immediately after a painful sting because of alarm at the intensity of the pain or worry about developing a serious, life-threatening reaction. Sometimes the patient seeks help the next day because of swelling, redness, and itching. Parents may not be aware that their child was stung by a bee and may…

Presentation The most common presentation is a dermatomal rash and pain. Prodromal symptoms, which occur infrequently, may include malaise, nausea and vomiting, headache, and photophobia. Less commonly there may be fever. During the prodromal stage, which can last several days, patients commonly experience preherpetic neuralgia. Patients complain of symptoms that range from an itch or tingling to severe lancinating pain, tenderness, dysesthesias, paresthesia, or hypersensitivity that…

Presentation Frostnip occurs when skin surfaces, such as the tip of the nose and ears, are exposed to an environment cold enough to freeze the epidermis. These prominent exposed surfaces become blanched and develop paresthesia and numbness but remain pliable. As they are rewarmed, they become hyperemic and are usually very painful. Pernio (chilblains) is an inflammatory skin injury caused by exposure to cold (often repeatedly)…

Presentation After wearing a pair of new or ill-fitting shoes or having gone on an unusually long hike or run, the patient complains of an uncomfortable open or intact blister on the posterior heel or ball of the foot. Occasionally these blisters will be hemorrhagic. Secondary infection may be the cause of the visit, after painful pustules, cellulitis, or lymphangitis develops. You’re Reading a Preview Become…

Presentation Usually the patient has experienced multiple burning stings (the so-called fire in the fire ant) and is seeking help because of local swelling, itching, and/or pain. Twenty-four hours after the initial wheal and flare at the sting site, there is formation of a small (2 mm), sterile, round pustule on an erythematous base, which is virtually pathognomonic for a fire ant sting ( Figs. 169.1…

Presentation Erysipelas is a superficial cutaneous infection commonly found on the legs or face and generally does not have an inciting wound or skin lesion. Erysipelas appears as a painful, fiery-red induration with raised and sharply demarcated borders, at times giving the skin a pitted appearance like an orange peel (peau d’orange) ( Fig. 168.1 ). In contrast, cellulitis involves the subcutaneous connective tissue and has…

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Presentation Patients present with intensely pruritic, thin, erythematous, serpiginous, raised eruptions on the sole of the foot, hand, or buttock ( Fig. 166.1 ). The patient may remember recently walking barefoot or sitting in the sand or soil in an area frequented by dogs or cats. Most commonly, this is seen in travelers returning from tropical or subtropical locations in the Caribbean, Central America, and South…

Presentation A patient with an abscess presents with localized pain, swelling, and redness of the skin. The patient may or may not have a history of minor trauma (such as an embedded foreign body or a small skin puncture). The area is tender, warm, firm, and usually fluctuant to palpation. Sometimes there is surrounding cellulitis or lymphangitis and, in the more serious case, fever. If the…