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…

Presentation Patients with bug or insect bites seek medical help because of itching, secondary infection, or anxiety about secondary effects such as communicable diseases or infestation. Skin lesions generally consist of single or multiple pruritic wheals or papules, which may include excoriations from scratching ( Fig. 164.1 ). Mosquito bites most often occur on skin-exposed areas in the summer in mosquito-infested environments ( Fig. 164.2 ).…

Presentation Occasionally patients will come in with a dead or captured spider after having rolled over it in bed or finding it in their clothing while dressing. They may have felt a minor pinprick sensation or no discomfort at all. Early presentations may show only mild erythema at the suspected bite site. Burning pain, pruritus, and swelling may develop within a few hours of the bite.…

Presentation Patients present with a very pruritic, eczematous-like rash at sites of skin exposure to allergens. Lesions may consist of small papules, vesicles, or bullae that may be confluent. Inflammation may exist with erythema, edema, oozing, or crusting. Dermatitis may remain localized at contact sites or, in severe cases, can spread to involve distant body areas. Sites with thin skin (e.g., eyelids [ Fig. 162.1 ],…

Presentation Usually a child (or parent) has dressed (the child) too quickly and, possibly not wearing underpants, has accidentally pulled penile skin into his zipper ( Fig. 161.1 ). The skin becomes entrapped and crushed between the teeth and the actuator (slide) of the zipper, thereby painfully attaching the article of clothing to the body part involved (most often the penis, or less often the area…

Presentation The patient has fallen onto a coarse surface, such as a blacktop or macadam road. Most frequently, the skin of the face, forehead, chin, hands, and knees is abraded. When pigmented foreign particles are impregnated within the dermis, tattooing will occur. An explosive form of tattooing can also be seen with the use of firecrackers, firearms, and homemade bombs. You’re Reading a Preview Become a…

Presentation A patient comes to the emergency department or clinic with an earlobe torn by a sudden pull on an earring. Contributing factors might include previous lengthening of the earlobe hole because of long-term use of relatively heavy or dangling ear jewelry, or the original earring hole may have been placed in an excessively low position. Patients with this type of injury require lobuloplasty to maximize…

Presentation A patient is brought in by police officers after being subdued with a Taser. A Taser is a type of conducted electrical weapon (CEW) that fires two barbed darts using a compressed nitrogen charge. The darts penetrate light clothing and embed in the skin. Electricity is conducted through fine insulated copper wires, resulting in neuromuscular incapacitation. You’re Reading a Preview Become a Clinical Tree membership…