NEJM â Collection Updates for Dermatology

IMAGES IN CLINICAL MEDICINE: Cutaneous Larva Migrans

Chia Chun Ang, M.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

A 42-year-old man presented with a 1-week history of intensely pruritic eruption on the dorsum of his right foot. He had gone for a barefoot stroll on the beach a...

IMAGES IN CLINICAL MEDICINE: Generalized Ostraceous Psoriasis

Salvador Antonio Arias-Santiago, M.D. and RamÃ³n Naranjo-Sintes, Ph.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

A 47-year-old woman presented to our hospital with a 2-week history of widespread, painful lesions on her trunk and limbs (Panels A and B). Her medical history included hypercholesterolemia, diabetes,...

ORIGINAL ARTICLE: Comparison of Ustekinumab and Etanercept for Moderate-to-Severe Psoriasis

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Background: Biologic agents offer a range of new therapeutic options for patients with psoriasis; however, the relative benefitârisk profiles of such therapies are not well known. We compared two biologic...

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

Laura McGevna, M.D. and Zarry Tavakkol, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Dr. Benjamin Sandefur (Emergency Medicine): A 16-year-old boy was admitted to the hospital after being found unconscious in a snow bank at 6 a.m. on New Year's Day. He had...

CORRESPONDENCE: COX-2 Inhibitors in Patients with Sensitivity to Nonselective NSAIDs

Stefan Cimbollek, M.D., Joaquin Quiralte, M.D., Ph.D., and Robledo Avila, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

To the Editor: Controlled oral challenge is the only definitive way to detect sensitivity to nonsteroidal antiinflammatory drugs (NSAIDs) in patients with adverse reactions to these agents.1 Patients who have...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

Daniela Kroshinsky, M.D., Jonathan Kay, M.D., and Rosalynn M. Nazarian, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

A 46-year-old woman was referred to a rheumatologist at this hospital because of swelling of the legs and skin changes.

The patient had been in her usual state of health until...

IMAGES IN CLINICAL MEDICINE: Chromoblastomycosis

Alcides Troncoso, M.D., Ph.D. and Javier Bava, M.D., Ph.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

A 55-year-old man presented with vegetating lesions on the right foot that had been slowly enlarging during the past several years. On physical examination, several nodular and verrucous lesions were...

ORIGINAL ARTICLE: Combined Immunodeficiency Associated with Mutations

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: Recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE are features of some variants of combined immunodeficiency. The genetic causes of these variants are unknown.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Geographic Tongue

Emili Masferrer, M.D. and Anna Jucgla, M.D. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

A 61-year-old man was referred for treatment of painless white lesions on his tongue that had appeared 1 month earlier. He had been treated with topical and systemic antifungal drugs...

EDITORIAL: Yeast Infections â Human Genetics on the Rise

Steven M. Holland, M.D., and Donald C. Vinh, M.D. — Thu, 29Â OctÂ 2009 00:00:00 -05:00

We lead inextricably mycotic lives: yeasts leaven our bread, ferment our wine and beer, and inhabit our skins, mouths, and gastrointestinal tracts; however, not all is harmony. Hippocrates reported aphthous...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2009 â A 20-Year-Old Man with Sore Throat, Fever, and Rash

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Dr. Robert W. McGarrah (Medicine): A 20-year-old man was admitted to this hospital because of sore throat, fever, and a diffuse rash.

The patient had been well until approximately 4 weeks...

ORIGINAL ARTICLE: Human Dectin-1 Deficiency and Mucocutaneous Fungal Infections

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Mucocutaneous fungal infections are typically found in patients who have no known immune defects. We describe a family in which four women who were affected by either recurrent vulvovaginal candidiasis...

ORIGINAL ARTICLE: A Homozygous Mutation in a Family with Susceptibility to Fungal Infections

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Background: Chronic mucocutaneous candidiasis may be manifested as a primary immunodeficiency characterized by persistent or recurrent infections of the mucosa or the skin with candida species. Most cases are sporadic,...

IMAGES IN CLINICAL MEDICINE: Pachyderma

Pooja Khera, M.D. and Joseph C. English, M.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

A 65-year-old white man with a history of multiple myeloma presented with thick, leathery, gray skin of the torso and extremities. Panel A shows the left axilla. The patient reported...

CORRESPONDENCE: Aprepitant as an Antipruritic Agent?

Arnaud Duval, M.D. and Louis Dubertret, M.D., Ph.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

To the Editor: The SÃ©zary syndrome is a leukemic, cutaneous, epidermotropic T-cell lymphoma. Pruritus, insomnia, and depression impair the quality of life and can lead to suicide.1 Substance P is...

IMAGES IN CLINICAL MEDICINE: Diagnostic Finding in the Iris

Bogomil Voykov, M.D. and Emmanuella Guenova, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

A 51-year-old woman was found to have a small, pinkish tumor of the left iris (Panels A and B, arrows). The visual acuity was not affected, and the intraocular pressure...

IMAGES IN CLINICAL MEDICINE: Acquired Melanonychia

Dana Ranta, M.D. and Caroline Bonmati, M.D. — Thu, 17Â SepÂ 2009 00:00:00 -05:00

An 80-year-old woman presented with longitudinal melanonychia, or longitudinal dark pigmentation of the nails (arrows). She first noticed it more than a year after the start of hydroxyurea treatment for...

ORIGINAL ARTICLE: Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Background: Mutations in hedgehog pathway genes, primarily genes encoding patched homologue 1 (PTCH1) and smoothened homologue (SMO), occur in basal-cell carcinoma. In a phase 1 clinical trial, we assessed the...

IMAGES IN CLINICAL MEDICINE: Giant Congenital Nevus

Tamilarasu Kadhiravan, M.D. and Surendra K. Sharma, M.D., Ph.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

A 17-year-old boy presented with painful swelling of the front of his chest after a roadside brawl. He had been born with a birthmark on his chest that had grown...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

Jeremy S. Abramson, M.D., Subba Digumarthy, M.D., and Judith A. Ferry, M.D. — Thu, 27Â AugÂ 2009 00:00:00 -05:00

Dr. David T. Ting (Medical Oncology): A 56-year-old woman was admitted to this hospital because of fever, rash, and lymphadenopathy.

She had been well until 11 weeks earlier when, while residing...

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 56-year-old woman presented to the emergency room with a 4-week history of malaise. During that time, her primary physician had ordered basic laboratory studies, which were normal except for...

REVIEW ARTICLE: Psoriasis

Frank O. Nestle, M.D., Daniel H. Kaplan, M.D., Ph.D., and Jonathan Barker, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Psoriasis is important to the clinician because it is common and has treatment implications beyond the care of skin lesions. It is important to the physician-scientist because it serves as...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2009 â A 59-Year-Old Man with Skin and Pulmonary Lesions after Chemotherapy for Leukemia

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Dr. Deborah L. Cummins (Dermatology): A 59-year-old man was seen by consultants in infectious disease and dermatology because of cutaneous and pulmonary lesions that developed after induction chemotherapy for acute...

IMAGES IN CLINICAL MEDICINE: Traumatic Bleb

Demetrios Vavvas, M.D., Ph.D. and Katarzyna Brodowska, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

A 38-year-old man was referred for evaluation of a large, pigmented lesion in the left eye for possible uveal melanoma. The patient reported that the growth had developed during the...

IMAGES IN CLINICAL MEDICINE: Cutaneous Anthrax

Mohsen Esfandbod, M.D. and Mahdi Malekpour, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

A 17-year-old girl presented to the emergency department with a black necrotic lesion on her left cheek and periorbital edema. She had been well until 15 days before presentation, when...

IMAGES IN CLINICAL MEDICINE: Tattoo Allergy

Joel Cook, M.D. and John Metcalf, M.D. — Thu, 02Â JulÂ 2009 00:00:00 -05:00

A 40-year-old man presented with intractable pruritus within portions of a tattoo imprinted with red ink on the left leg (Panel A). The intense localized itching had begun approximately 4...

IMAGES IN CLINICAL MEDICINE: Lipomatosis of the Tongue

Hiroshi Murakami, M.D. and Naoki Tamasawa, M.D. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

An 88-year-old man presented with diffuse, painless swelling of the lateral borders of his tongue (Panel A). The swelling had been slowly increasing during the previous 20 years. Yellowish tumors...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2009 â A 79-Year-Old Woman with a Blistering Cutaneous Eruption

Mathew M. Avram, M.D., J.D., and Mai Hoang, M.D. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

Dr. Jordan M. Cummins (Dermatology): A 79-year-old woman was admitted to the burn unit of this hospital because of a blistering cutaneous eruption.

Five days before admission, itching on her head...

ORIGINAL ARTICLE: An Autoinflammatory Disease Due to Homozygous Deletion of the Locus

Thu, 04Â JunÂ 2009 00:00:00 -05:00

We describe a patient with an autoinflammatory disease in which the main clinical features are pustular rash, marked osteopenia, lytic bone lesions, respiratory insufficiency, and thrombosis. Genetic studies revealed a...

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

Thu, 04Â JunÂ 2009 00:00:00 -05:00

Background: Autoinflammatory diseases manifest inflammation without evidence of infection, high-titer autoantibodies, or autoreactive T cells. We report a disorder caused by mutations of IL1RN, which encodes the interleukin-1âreceptor antagonist, with...

IMAGES IN CLINICAL MEDICINE: Tongue Necrosis in a Patient with Essential Thrombocytosis

Alejandro Fernandez-Casado, M.D. and Blanca Sanchez-Gonzalez, Ph.D. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

A 69-year-old woman with complete atrioventricular block was admitted for implantation of a pacemaker. Her medical history included multiple sclerosis with tetraparesis. She had been taking acenocoumarol for the previous...

BOOK REVIEW:

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Few conditions are more devastating to the physical, emotional, and social health of an infant or child than epidermolysis bullosa. The disease is actually a group of congenital abnormalities of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Dr. Katharina Busl (Neurology): A 30-year-old man was admitted to this hospital because of progressive neurologic deficits.

Approximately 1 year before this admission, he began to have intermittent headaches and the...

CORRESPONDENCE: Nickel Allergy in Danish Women before and after Nickel Regulation

Thu, 21Â MayÂ 2009 00:00:00 -05:00

To the Editor: Over the 20th century, the prevalence of nickel allergy increased in Western Europe and the United States1; this increase has been attributed to increased skin exposure to...

IMAGES IN CLINICAL MEDICINE: White Tongue

Mohiba Tareen, M.D. and Marc E. Grossman, M.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

A 55-year-old male nonsmoker with multiple myeloma refractory to chemotherapy was admitted to the hospital for autologous stem-cell transplantation. Palifermin was to be administered before and after the transplantation. On...

IMAGES IN CLINICAL MEDICINE: Extravasation of Epirubicin

Sergio Vano-Galvan, M.D. and Pedro Jaen, M.D., Ph.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

A 63-year-old woman with a diagnosis of infiltrative ductal carcinoma of the breast (stage T2N1M0[IIB], according to the tumorânodeâmetastasis staging system) that was estrogen receptorânegative and HER2-negative was referred for...

CLINICAL PRACTICE: Fungal Nail Disease

David de Berker, M.R.C.P. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

A 68-year-old man reports changes in his left big toenail. It has been discolored distally for the past 2 years. It has become thickened and difficult to cut and is...

REVIEW ARTICLE: Scleroderma

Armando Gabrielli, M.D., Enrico V. Avvedimento, M.D., and Thomas Krieg, M.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

Scleroderma (systemic sclerosis) is a complex disease in which extensive fibrosis, vascular alterations, and autoantibodies against various cellular antigens are among the principal features (Figure 1 and Figure 2).1 There...

IMAGES IN CLINICAL MEDICINE: Familial Hypercholesterolemia

Sheng Guang Li, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

An 18-year-old woman with familial hypercholesterolemia presented with a 4-year history of swelling and pain in the joints. She was born with multiple xanthomas, which grew in size as she...

CORRESPONDENCE: Revertant Mosaicism â Patchwork in the Skin

Marcel F. Jonkman, M.D., Ph.D. and Anna M.G. Pasmooij, Ph.D. — Thu, 16Â AprÂ 2009 00:00:00 -05:00

To the Editor: Revertant mosaicism occurs when an inherited disease-causing mutation is corrected by a spontaneous genetic event within a somatic cell, followed by expansion of this reverted cell.1 This...

IMAGES IN CLINICAL MEDICINE: Gingival and Periungual Vasculopathy of Juvenile Dermatomyositis

Lisa G. Rider, M.D. and Jane C. Atkinson, D.D.S. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

A 16-year-old girl with long-standing juvenile dermatomyositis had an illness marked by intermittent clinical flares, including increased muscle weakness, joint contractures, photosensitive rashes, and dysphagia, despite treatment with multiple immunosuppressive...

IMAGES IN CLINICAL MEDICINE: Lupoid Leishmaniasis

Taoufik Zaz, M.D. and Hamida Turki, M.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

A 52-year-old woman from southern Tunisia presented with a 2-year history of an asymptomatic, thick, reddish plaque on her right ear. The lesion began as multiple erythematous papules that later...

IMAGES IN CLINICAL MEDICINE: Penile Papules

Nicolas Kluger, M.D. and Olivier Dereure, M.D., Ph.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

A 59-year-old man was referred to our hospital for the management of genital warts. Multiple, asymptomatic, smooth, round, skin-colored papules were observed at the corona of the glans penis. Physical...

IMAGES IN CLINICAL MEDICINE: Green Nails

Ulrich R. Hengge, M.D. and Virginia Bardeli, M.D. — Thu, 12Â MarÂ 2009 00:00:00 -05:00

A 53-year-old intensive care nurse receiving monotherapy with efalizumab for psoriasis involving her arms, legs, and nails presented with a several-week history of slowly progressive green discoloration of both thumbnails,...

BOOK REVIEW:

Thu, 05Â MarÂ 2009 00:00:00 -05:00

Interest in hair biology and clinical trichology has increased during the past 20 years, and there have been considerable advances in our understanding of the biology and treatment of hair...

IMAGES IN CLINICAL MEDICINE: Lymphedema Tarda

Jose A. Melendez Burgos, M.D. and Adam Luginbuhl, M.D. — Thu, 05Â MarÂ 2009 00:00:00 -05:00

A 42-year-old woman was admitted with hypotension. Sepsis was diagnosed, which was probably caused by cellulitis related to chronic severe edema, skin breakdown, and lichenification of both legs (Panels A...

CLINICAL THERAPEUTICS: Excision and Skin Grafting of Thermal Burns

Dennis P. Orgill, M.D., Ph.D. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

A 45-year-old man was rescued from his burning house. Firefighters removed his smoldering clothes and initiated intravenous access, pulse oximetry, and electrocardiographic monitoring. An endotracheal tube was inserted, and ventilation...

IMAGES IN CLINICAL MEDICINE: Pediculosis of the Pubis

Sung Bin Cho, M.D. and Hyung Su Kim, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

A 22-year-old man presented with a 1-month history of severe pubic itch that was worst at night. He had had a new sexual partner 1 week before the onset of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Dr. John H. Stone: A 47-year-old woman was seen in the Rheumatology Clinic of this hospital because of numbness and pain in the legs and a rash.

The patient had been...

BOOK REVIEW:

Thu, 05Â FebÂ 2009 00:00:00 -05:00

In this latest addition to the Current Directions in Autoimmunity series from Karger, a broad spectrum of immune-mediated cutaneous diseases, including most of the major disorders that are known to...

IMAGES IN CLINICAL MEDICINE: Metallic Mercury Embolism to the Hand

Antonio Carlos de Souza and Adelino Moreira de Carvalho, M.D., M.Sc., Ph.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

Severe pain developed in the left hand of a 46-year-old woman after open heart surgery was performed to repair an atrial septal defect. It was initially thought that this pain...

CLINICAL PRACTICE: Seborrheic Dermatitis

Luigi Naldi, M.D., and Alfredo Rebora, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

A 35-year-old man reports itching, redness, and scaling in his scalp, eyebrows, and external auditory canal. He has tried several over-the-counter dandruff shampoos, with only temporary relief, and he is...

CORRESPONDENCE: An Î±-MelanocyteâStimulating Hormone Analogue in Erythropoietic Protoporphyria

Thu, 15Â JanÂ 2009 00:00:00 -05:00

To the Editor: Patients with erythropoietic protoporphyria, a rare inherited disease, accumulate photosensitizing protoporphyrin in the dermis, which results in severe dermal pain and incapacitating phototoxic reactions when the skin...

IMAGES IN CLINICAL MEDICINE: Spider Angiomas

Olivier Detry, M.D., Ph.D. and Arnaud De Roover, M.D., Ph.D. — Thu, 15Â JanÂ 2009 00:00:00 -05:00

A 55-year-old man with end-stage liver disease associated with alcohol abuse was evaluated for liver transplantation. He had a history of refractory ascites and hepatic encephalopathy. On physical examination, we...

IMAGES IN CLINICAL MEDICINE: Medication-Induced Gingival Hypertrophy

Dong-Soo Yu, M.D. and Young-Bok Lee, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

A 30-year-old man presented with multiple asymptomatic, firm, polypoid, erythematous nodules on the upper and lower gingivae, which had developed during the previous 10 years. The patient had spastic quadriparesis...

CLINICAL PRACTICE: Vitiligo

Alain TaÃ¯eb, M.D., and Mauro Picardo, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

A healthy 25-year-old brunette woman reports a 12-month history of skin depigmentation. She first noticed patches of skin whitening on her hips; her physician prescribed an imidazole cream for a...

IMAGES IN CLINICAL MEDICINE: Subungual Exostosis

Alexandre Campanelli, M.D. and Luca Borradori, M.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

A 12-year-old girl with an unremarkable history was evaluated for a nodule of the lateral nail fold on the right hallux that had been present for 3 months (Panel A)....

CORRESPONDENCE: Small-Cell Lung Cancer and Necrolytic Migratory Erythema

Thu, 18Â DecÂ 2008 00:00:00 -05:00

To the Editor: Necrolytic migratory erythema is a rare inflammatory dermatosis, first described by Becker et al.,1 which occurs in 70% of patients with the glucagonoma syndrome.2 Its clinical features...

IMAGES IN CLINICAL MEDICINE: Periungual Tungiasis

Michael Muehlstaedt, M.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe (Panel A). Two weeks before presentation, he had returned...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

James G.H. Dinulos, M.D., and Artur Zembowicz, M.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

Dr. Melissa M. Burnett (Pediatric Dermatology): A 10.8-year-old girl was seen in the Pediatric Dermatology Clinic of this hospital because of recurrent oral ulcers and cutaneous bullae.

The patient was well...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

James G.H. Dinulos, M.D., and Artur Zembowicz, M.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

IMAGES IN CLINICAL MEDICINE: Keratoacanthoma

Rachid Frikh, M.D. and Omar Sedrati, M.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

A 45-year-old man presented with a kerotic nodule of the second right toe that had been increasing in size for 4 months. There was no history of trauma and no...

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

Sarah P. Hammond, M.D., and Lindsey R. Baden, M.D. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

In early September, we presented a case of a college athlete with a skin and soft-tissue infection in Clinical Decisions,1 an interactive feature designed to assess how readers would manage...

CORRESPONDENCE: A Case of Conjugal Azathioprine-Induced Contact Hypersensitivity

Thu, 02Â OctÂ 2008 00:00:00 -05:00

To the Editor: A man in his early 30s presented with an intermittent eczematous eruption over the shaft of his penis and scrotum (Figure 1A). His wife was initially concerned...

IMAGES IN CLINICAL MEDICINE: Periungual Fibromas

Anthony Dacunha, M.D. — Thu, 25Â SepÂ 2008 00:00:00 -05:00

A 36-year-old woman with mild mental retardation and facial angiofibromas presented for evaluation of recurrent seizures, which she reported having had since childhood. Periungual fibromas were seen in the feet....

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection

Thu, 04Â SepÂ 2008 00:00:00 -05:00

A 20-year-old college basketball player presents to the emergency department with a 2-day history of a red, painful area on his right buttock. He reports that there was no specific...

IMAGES IN CLINICAL MEDICINE: Bedbug Bites

Armin Stucki, M.D. and Roger Ludwig, M.D. — Thu, 04Â SepÂ 2008 00:00:00 -05:00

A 30-year-old healthy woman presented with pruritic papules on both arms and breasts. Physical examination revealed multiple erythematous papules in a partially linear pattern. The patient had stayed in a...

IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma Manifesting as a Cutaneous Horn

Sergio Vano-Galvan, M.D. and Alberto Sanchez-Olaso, Ph.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A healthy 84-year-old woman presented with a 6-month history of a slowly growing asymptomatic lesion on the dorsum of her right hand. Physical examination revealed a keratotic cutaneous horn â...

CORRESPONDENCE: Scrotal Cutaneous Side Effects of Sunitinib

Thu, 28Â AugÂ 2008 00:00:00 -05:00

To the Editor: Sunitinib is an oral, multitargeted kinase that blocks the receptors for vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and stem-cell factor (c-kit). Sunitinib was approved...

IMAGES IN CLINICAL MEDICINE: The StewartâTreves Syndrome

Laura B. Pincus, M.D. and Lindy P. Fox, M.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A 67-year-old woman with a history of cancer of the right breast, treated with a modified radical mastectomy, radiation, and chemotherapy in 1990, presented with a 6-month history of an...

IMAGES IN CLINICAL MEDICINE: Allergic Contact Dermatitis from a Henna Tattoo

Colby C. Evans, M.D. and John D. Fleming, M.B., B.S. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

A 19-year-old otherwise healthy Kuwaiti woman presented 8 days after the brush application of a temporary henna tattoo while in Kuwait for a wedding. Burning and itching at the site...

IMAGES IN CLINICAL MEDICINE: Vitiligo and Cutaneous Melanoma

Pedro Redondo, M.D. and Julio Del Olmo, M.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

A 58-year-old woman presented with white facial patches that had progressively increased in size during a period of several months. She had no other illnesses. Physical examination revealed hypopigmented macules...

IMAGES IN CLINICAL MEDICINE: Digital Verrucae

Nektarios I. Lountzis, M.D. and Omar Rahman, M.D. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

A 34-year-old woman underwent renal transplantation for chronic idiopathic glomerulonephritis, and 4 years later small verrucae developed on her distal fingertips. Over the course of 11 years after transplantation, during...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

Thu, 26Â JunÂ 2008 00:00:00 -05:00

Dr. Allyson K. Bloom (Medicine): A 57-year-old woman was admitted to this hospital because of abdominal pain and weakness. One month earlier, a laparoscopic Roux-en-Y gastric bypass and cholecystectomy were...

IMAGES IN CLINICAL MEDICINE: Systemic Sclerosis and Acral Osteolysis

Leonardo Astudillo, M.D. and Elisabeth Arlet-Suau, M.D. — Thu, 26Â JunÂ 2008 00:00:00 -05:00

A 71-year-old woman received a diagnosis of systemic sclerosis more than 30 years ago when she presented with Raynaud's phenomenon and cutaneous sclerosis. At that time she did not require...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2008 â A 63-Year-Old HIV-Positive Man with Cutaneous Merkel-Cell Carcinoma

Thu, 19Â JunÂ 2008 00:00:00 -05:00

Dr. Gregory K. Robbins (Infectious Diseases): A 63-year-old man was referred to the clinic for head and neck cancer, a multidisciplinary unit of this hospital, for management of cutaneous Merkel-cell...

ORIGINAL ARTICLE: Treatment of Metastatic Melanoma with Autologous CD4+ T Cells against NY-ESO-1

Thu, 19Â JunÂ 2008 00:00:00 -05:00

We developed an in vitro method for isolating and expanding autologous CD4+ T-cell clones with specificity for the melanoma-associated antigen NY-ESO-1. We infused these cells into a patient with refractory...

CLINICAL PROBLEM-SOLVING: A Joint Venture

Thu, 05Â JunÂ 2008 00:00:00 -05:00

A 59-year-old woman presented with new-onset oligoarthritis and extreme fatigue. The patient had been in her usual state of health until 6 weeks earlier, when she noted a gradual onset...

IMAGES IN CLINICAL MEDICINE: Keratoderma Blennorrhagica

Ivan Tonna, M.R.C.P. and Robert B.S. Laing, M.D., F.R.C.P.E. — Thu, 15Â MayÂ 2008 00:00:00 -05:00

A 55-year-old bisexual man presented with a few weeks' history of lethargy followed by the onset of a widespread nonpruritic rash that covered much of his body, including the palms...

IMAGES IN CLINICAL MEDICINE: Fluorescence Diagnosis of Subclinical Actinic Keratoses

Onofre Sanmartin, M.D. and Carlos Guillen, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Photodynamic therapy is a noninvasive therapy for nonhyperkeratotic actinic keratoses and basal-cell carcinoma. Photodynamic therapy involves the activation of a photosensitizing drug by visible light to produce activated oxygen species...

IMAGES IN CLINICAL MEDICINE: Nevus Sebaceus of Jadassohn

Sherrif F. Ibrahim, M.D., Ph.D. and John H. Tu, M.D. — Thu, 01Â MayÂ 2008 00:00:00 -05:00

A 14-year-old girl came to the hospital with her mother, stating that a small birthmark on the scalp had recently started growing rather rapidly. It was increasingly pruritic and caused...

IMAGES IN CLINICAL MEDICINE: Vestibular Papillomatosis

Chih-Chieh Chan, M.D. and Hsien-Ching Chiu, M.D. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

A 34-year-old woman presented to her primary care physician with vulvar pruritus, which she reported having had for several months. A diagnosis of condyloma on the vulvae was made, and...

REVIEW ARTICLE: Atopic Dermatitis

Thomas Bieber, M.D., Ph.D. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

Atopic dermatitis, or eczema, is a common skin disease that is often associated with other atopic disorders, such as allergic rhinitis and asthma.1 The clinical manifestations of atopic dermatitis (Figure...

ORIGINAL ARTICLE: Treatment of Vulvar Intraepithelial Neoplasia with Topical Imiquimod

Thu, 03Â AprÂ 2008 00:00:00 -05:00

Background: Alternatives to surgery are needed for the treatment of vulvar intraepithelial neoplasia. We investigated the effectiveness of imiquimod 5% cream, a topical immune-response modulator, for the treatment of this...

IMAGES IN CLINICAL MEDICINE: Erlotinib-Induced Hair Alterations

Peter Arne Gerber, M.D. and Bernhard Homey, M.D. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

A 55-year-old woman with metastatic lung cancer was treated with erlotinib, a tyrosine kinase inhibitor of the epidermal growth factor receptor. Cutaneous toxic effects are specific to this class of...

IMAGES IN CLINICAL MEDICINE: Chronic Venous Insufficiency and Dystrophic Subcutaneous Calcification

David Miedinger, M.D. and Thomas Daikeler, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

A 70-year-old woman was referred by her general practitioner for evaluation of an ulcerative lesion on her lower right leg. Subcutaneous white calcifications were seen (Panel A, arrow). She had...

IMAGES IN CLINICAL MEDICINE: Severe Soft-Tissue Infection

Fone-Ching Hsiao, M.D. and Chang-Hsun Hsieh, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

A 65-year-old woman with a 15-year history of diabetes presented with fever (temperature, 38.5Â°C), chills, malaise, and a rash on the medial surface of the right thigh, vulva, and lower...

IMAGES IN CLINICAL MEDICINE: Cold-Induced Urticaria

Aarnoud Huissoon, Ph.D. and Mamidipudi Thirumala Krishna, Ph.D. — Thu, 21Â FebÂ 2008 00:00:00 -05:00

A 43-year-old woman presented with a 10-month history of an urticarial rash induced by cold, particularly when she was swimming. A clinical diagnosis of cold-induced urticaria was made. The diagnosis...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Dr. Nancy Cibotti-Granof (Medicine): A 46-year-old woman with end-stage renal disease was seen by a rheumatology consultant because of stiffness of her joints and skin.

The patient had been well except...

IMAGES IN CLINICAL MEDICINE: Blue Hives

Martin J. O'Sullivan, F.R.C.S.I. and Monica Morrow, M.D. — Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 77-year-old woman underwent surgical resection of a 1.5-cm papillary carcinoma of the right breast. Isosulfan blue dye (8 ml) was used intraoperatively to define the associated lymphatic drainage. Three...

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. He reported mild pleuritic...

IMAGES IN CLINICAL MEDICINE: Renal Failure from Vitamin C after Transplantation

Brian J. Nankivell, M.D., Ph.D. and Karumathil M. Murali, M.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

A 31-year-old woman with bilateral nephrectomy due to bleeding angiomyolipomas from tuberous sclerosis received a kidney transplant with good early graft function. Irreversible, oliguric renal allograft failure soon developed from...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2008 â An 80-Year-Old Woman with Cutaneous Basal-Cell Carcinomas and Cysts of the Jaws

Ervin H. Epstein, M.D., Jo-Anne O. Shepard, M.D., and Thomas J. Flotte, M.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

Dr. Gabriela Rolz-Cruz (Dermatology): An 80-year-old woman was seen in the outpatient clinic of this hospital for management of recurrent ulcerated skin lesions on the scalp.

When the patient was approximately...

ORIGINAL ARTICLE: Etanercept Treatment for Children and Adolescents with Plaque Psoriasis

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Background: Etanercept, a soluble tumor necrosis factor receptor, has been shown to lessen disease severity in adult patients with psoriasis. We assessed the efficacy and safety of etanercept in children...

IMAGES IN CLINICAL MEDICINE: Retiform Purpura

Dan Lipsker, M.D., Ph.D. and Fady Kara, M.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

A rapidly spreading, painful rash and confusion developed in a 46-year-old male patient with a history of chronic alcoholism. On physical examination, he was febrile and hypotensive and had a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2007 â A 5-Month-Old Girl with Skin Lesions

Melissa M. Burnett, M.D., Mary S. Huang, M.D., and Rania M. Seliem, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

Dr. Ruth Ann Vleugels (Dermatology): A 5-month-old girl was seen in the pediatric dermatology clinic because of a rash. She had been well until 3 months of age, when her...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2007 â A 44-Year-Old Woman with Generalized, Painful, Ulcerated Skin Lesions

Vincent Liu, M.D., Corey S. Cutler, M.D., M.P.H., and Alison Z. Young, M.D. — Thu, 13Â DecÂ 2007 00:00:00 -05:00

Dr. Michael Sherling (Dermatology): A 44-year-old woman was admitted to this hospital because of generalized, painful, ulcerated cutaneous lesions.

The patient had been well, except for eczema, until 4 years before...

CLINICAL PROBLEM-SOLVING: The Leading Diagnosis â A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration

Thomas E. Baudendistel, M.D., Amy K. Haase, M.D., and Faith Fitzgerald, M.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration. The pain was followed by nausea and episodes of bilious vomiting and...

IMAGES IN CLINICAL MEDICINE: Lingua Villosa Nigra

Asha Ramsakal, D.O., M.B.S. and Lovpreet Mangat, M.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

A 24-year-old man presented with black discoloration and hairy appearance of his tongue, which he had had for 2 days, and a sore throat. He had been taking ciprofloxacin and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2007 â A 31-Year-Old Woman with Rash, Fever, and Hypotension

Thu, 22Â NovÂ 2007 00:00:00 -05:00

Dr. Jeffrey O. Greenberg (Medicine): A 31-year-old woman was admitted to this hospital because of facial swelling, fever, and hypotension.

The patient had relapsing and remitting multiple sclerosis, associated with severe...

REVIEW ARTICLE: Sarcoidosis

Thu, 22Â NovÂ 2007 00:00:00 -05:00

The modern history of sarcoidosis, an enigmatic multisystem disease, goes back to 1899, when the pioneering Norwegian dermatologist Caesar Boeck coined the term to describe skin nodules characterized by compact,...

IMAGES IN CLINICAL MEDICINE: Harlequin's Darker Side

Martin E. Duddy, M.R.C.P. and Mark R. Baker, M.R.C.P. — Thu, 15Â NovÂ 2007 00:00:00 -05:00

A 39-year-old healthy, female aerobics instructor presented with a 6-week history of flushing on the left side of her face, neck, and upper trunk after 40 minutes of vigorous exercise,...

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

Don R. Martin, M.D., D. William Schlott, M.D., and John A. Flynn, M.D., M.B.A. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier. She...

EDITORIAL: STAT3 Signaling and the Hyper-IgE Syndrome

David E. Levy, Ph.D., and Cynthia A. Loomis, M.D., Ph.D. — Thu, 18Â OctÂ 2007 00:00:00 -05:00

The Janus kinase (JAK)âsignal transducer and activator of transcription (STAT) signaling pathway has emerged over the past decade as a major relay between cell-surface receptors and cytokine responses. The human...

CLINICAL PRACTICE: Hair Loss in Women

Jerry Shapiro, M.D. — Thu, 18Â OctÂ 2007 00:00:00 -05:00

A 45-year-old white woman presents with a 1-year history of scalp-hair loss. She was hospitalized with appendicitis 14 months ago. She has been a vegetarian for 20 years. She takes...

ORIGINAL ARTICLE: Mutations in the Hyper-IgE Syndrome

Thu, 18Â OctÂ 2007 00:00:00 -05:00

Background: The hyper-IgE syndrome (or Job's syndrome) is a rare disorder of immunity and connective tissue characterized by dermatitis, boils, cyst-forming pneumonias, elevated serum IgE levels, retained primary dentition, and...

IMAGES IN CLINICAL MEDICINE: White Phosphorus Dermal Burns

Johnathan C. Conner, M.D. and Vikhyat S. Bebarta, M.D. — Thu, 11Â OctÂ 2007 00:00:00 -05:00

A 19-year-old man presented with painful burns on his posterior scalp after exposure to an incendiary agent. Smoke emanated from the wounds on removal of the dressing that had been...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2007 â A Newborn Girl with Skin Lesions

Mathew M. Avram, M.D., J.D., Verena Gobel, M.D., and Alireza Sepehr, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Dr. Elizabeth A. Buzney (Dermatology): A newborn girl was transferred to this hospital because of a rash that had been present at birth. The infant, who weighed 3105 g, was...

IMAGES IN CLINICAL MEDICINE: Calciphylaxis with Arterial Calcification

Jonathan Z. Li, M.D. and William Huen, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

A 53-year-old woman with diabetes mellitus and end-stage renal disease who was undergoing hemodialysis presented with fever, painful finger necrosis, and nonhealing ulceration of the legs. Hand radiographs showed no...

IMAGES IN CLINICAL MEDICINE: Herpetic Glossitis

Chih-Chieh Chan, M.D. and Hsien-Ching Chiu, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A 75-year-old woman with more than a 10-year history of hypertension and diabetes mellitus reported a 3-day history of throat discomfort and white eruptions on the tongue. On examination, multiple...

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

Chuang-Wei Chen, M.D. and Shu-Wen Jao, Ph.D. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

A 20-year-old man presented for consideration of repair of a rectal prolapse that had been present since birth. Physical examination revealed hyperelasticity of the skin (Panel A) with easy bruisability,...

IMAGES IN CLINICAL MEDICINE: Oral Acanthosis Nigricans

Christina Schnopp, M.D. and Julia Baumstark, M.D. — Thu, 30Â AugÂ 2007 00:00:00 -05:00

A 44-year-old woman presented with increasing oral papillomatosis, predominantly on the lips and less pronounced on the tongue and buccal mucosa. The lips showed filiform papillomas in a symmetrical distribution...

IMAGES IN CLINICAL MEDICINE: Muehrcke's Lines

Maya Morrison-Bryant, M.D. and Jeremy D. Gradon, M.D. — Thu, 30Â AugÂ 2007 00:00:00 -05:00

A 46-year-old woman with metastatic sarcoma who had been treated with five cycles of doxorubicin, ifosfamide, and mesna chemotherapy presented with two symmetrical, horizontal white lines on all of her...

IMAGES IN CLINICAL MEDICINE: PeutzâJeghers Syndrome

Elizabeth Cureton, M.D. and Sunghoon Kim, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

A previously healthy 12-year-old boy presented with abdominal pain, vomiting, and abdominal distention of 3 days' duration. On physical examination, hyperpigmented macules were seen on his lips (Panel A). A...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

Thu, 16Â AugÂ 2007 00:00:00 -05:00

Dr. Sheila F. Mitsuma (Department of Medicine): A 60-year-old man was admitted to this hospital because of fever, odynophagia, weight loss, and rash.

He had been well until 5 months earlier,...

IMAGES IN CLINICAL MEDICINE: Pearly Penile Papules

Matilda Bylaite, M.D. and Thomas Ruzicka, M.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

A 19-year-old man was referred for treatment of multiple papular lesions that had appeared 8 years earlier on the glans of his circumcised penis and had been diagnosed as condyloma...

CLINICAL THERAPEUTICS: Psoralen and Ultraviolet A Light Therapy for Psoriasis

Robert S. Stern, M.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

A 52-year-old man who has had psoriasis since he was 20 years of age seeks further treatment. His psoriasis has varied in extent and severity over time, is not responsive...

EDITORIAL: Rituximab and Pemphigus â A Therapeutic Advance

Luis A. Diaz, M.D. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

Pemphigus vulgaris and pemphigus foliaceus are rare autoimmune blistering diseases of obscure causes. The scientific bases for the therapy of these disorders have evolved in the past 60 years. Landmark...

ORIGINAL ARTICLE: A Single Cycle of Rituximab for the Treatment of Severe Pemphigus

Thu, 09Â AugÂ 2007 00:00:00 -05:00

Background: The combination of multiple cycles of rituximab and intravenous immune globulins has been reported to be effective in patients with severe pemphigus. The aim of this study was to...

IMAGES IN CLINICAL MEDICINE: Cellulitis after Treatment for Breast Cancer

Gheorghe Peltecu, M.D., Ph.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

A 54-year-old woman presented with a sudden onset of fever (temperature, 39.3Â°C) and erythema on the right breast and right arm (Panel A) and on the right side of the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2007 â A 9-Year-Old Boy with Bone Pain, Rash, and Gingival Hypertrophy

Thu, 26Â JulÂ 2007 00:00:00 -05:00

Dr. Laura Chapman (Pediatrics): A 9-year-old boy with autism was admitted to this hospital because of pain in the hip, refusal to walk, and the recent onset of a rash...

CLINICAL PRACTICE: Skin and Soft-Tissue Infections Caused by Methicillin-Resistant

Robert S. Daum, M.D., C.M. — Thu, 26Â JulÂ 2007 00:00:00 -05:00

A 37-year-old man presents for the evaluation of localized swelling and tenderness of the left leg just below the knee. He suspects this lesion developed after a spider bite, although...

IMAGES IN CLINICAL MEDICINE: Nephrogenic Fibrosing Dermopathy

Vesna D. Garovic, M.D. and Katherine E. Helgen, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

A 70-year-old man was admitted to the hospital for evaluation of thickening of the skin. Four years earlier, he had undergone kidney transplantation for hypertension-induced end-stage renal disease. Two months...

IMAGES IN CLINICAL MEDICINE: Phytophotodermatitis and Limes

Miriam Keltz Pomeranz, M.D. and Julie K. Karen, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

A 23-year-old woman presented to the emergency department with a 3-day history of a painful, erythematous, blistering rash across her sun-exposed skin. Before the onset of the rash, the patient...

IMAGES IN CLINICAL MEDICINE: Severe Digital Ischemia

Rafael S. Cires, M.D. and Susana V. Maya, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

A 56-year-old woman with diabetes mellitus complicated by retinopathy and mild nephropathy and managed with glyburide (glibenclamide) and metformin reported having abdominal pain and fever for the past 48 hours....

IMAGES IN CLINICAL MEDICINE: Saddle Nose Deformity

Sandeep Chauhan, M.D. and Sanjay D'Cruz, M.D., D.M. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

A 44-year-old man presented with intermittent epistaxis, fever, and polyarthralgias of 2 months' duration. For the previous week, he had had puffiness of the face and reduced urinary output. On...

CLINICAL PROBLEM-SOLVING: A Hand-Carried Diagnosis â A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

Thu, 07Â JunÂ 2007 00:00:00 -05:00

A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise. Her colleagues had noticed yellowing of her eyes over the past few days. The patient...

IMAGES IN CLINICAL MEDICINE: Amyloid Purpura

Lihi Eder, M.D. and Haim Bitterman, M.D. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

A 73-year-old woman presented with new-onset periorbital purpuric, nonblanching, nonpruritic lesions. The lesions appeared spontaneously and were not associated with any recent trauma. She did not take aspirin, nonsteroidal antiinflammatory...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A Healthy Tan?

Gregory Barsh, M.D., Ph.D., and Laura D. Attardi, Ph.D. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

For the past 500 million years or so, the tumor suppressor and transcription factor known as p53 has been the guardian of the genome in multicellular organisms. It mediates the...

IMAGES IN CLINICAL MEDICINE: The Sign of LeserâTrÃ©lat

Saadettin Kilickap, M.D. and Basak Yalcin, M.D. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A healthy 65-year-old man presented with a 4-month history of left flank pain and nocturia. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous...

IMAGES IN CLINICAL MEDICINE: Lymphomatous Infiltration of the Eyelids

Carole A. Cooke, M.R.C.Ophth. and Steve T. White, F.R.C.Ophth. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

A healthy 70-year-old man presented with a 2-month history of painless swelling of his right upper and lower eyelids. The swelling had been treated with antibiotics, with no improvement. He...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2007 â A 59-Year-Old Man with Fever and Pain and Swelling of Both Eyes and the Right Ear

Thu, 10Â MayÂ 2007 00:00:00 -05:00

Dr. David T. Ting (Medicine): A 59-year-old man was admitted to this hospital because of fever as well as pain and swelling of both eyes, which was worse in the...

CLINICAL PROBLEM-SOLVING: Building a Diagnosis from the Ground Up â A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever

Thu, 05Â AprÂ 2007 00:00:00 -05:00

A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever. On examination, he had a temperature of 38.1Â°C but appeared well. A urinalysis revealed...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Skin Discolorations in a Bank Employee

Stefan Schanz, M.D. and Gisela Metzler, M.D. — Thu, 05Â AprÂ 2007 00:00:00 -05:00

A healthy 34-year-old female bank employee presented with black discolorations of the skin on all her fingers. The discolorations had developed in the evening, after work. She was unable to...

IMAGES IN CLINICAL MEDICINE: Conjunctival Viral Papilloma

Wasee Tulvatana, M.D. and Kittisak Kulvichit, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

A healthy 9-year-old boy had a 1-year history of an itchy right eye with frequent tearing. Small masses that gradually developed in the right caruncula lacrimalis area were associated with...

CLINICAL THERAPEUTICS: VaricellaâZoster Vaccine for the Prevention of Herpes Zoster

David W. Kimberlin, M.D., and Richard J. Whitley, M.D. — Thu, 29Â MarÂ 2007 00:00:00 -05:00

A 64-year-old man presents to his internist for his annual examination. He has been in good general health, although he received a diagnosis of pneumonia 8 months ago, for which...

ORIGINAL ARTICLE: Redarkening of Port-Wine Stains 10 Years after Pulsed-DyeâLaser Treatment

Thu, 22Â MarÂ 2007 00:00:00 -05:00

Background: Although pulsed-dyeâlaser therapy is currently the gold standard for the treatment of port-wine stains, few objective data are available on its long-term efficacy. Using objective color measurements, we performed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2007 â A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers

Thu, 08Â MarÂ 2007 00:00:00 -05:00

Dr. Maha R. Farhat (Medicine): A 59-year-old woman was admitted to the hospital because of a nonhealing ulcer on the right heel and painful ulcers on the right thigh and...

IMAGES IN CLINICAL MEDICINE: Erythema Ab Igne

Chih-Chieh Chan, M.D. and Hsien-Ching Chiu, M.D. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

A healthy 69-year-old man with osteoarthritis of the knees presented with a 2-week history of mottled darkening of the skin on the left thigh. On examination, there was a reticular,...

IMAGES IN CLINICAL MEDICINE: Hydrofluoric Acid Burn

Martin W. DÃ¼nser, M.D. and Josef Rieder, M.D. — Thu, 08Â FebÂ 2007 00:00:00 -05:00

A 45-year-old healthy man was involved in demolishing an industrial plant in which glass had been etched. He was exposed to a reservoir of 70% hydrofluoric acid while repairing a...

ORIGINAL ARTICLE: A Human Interleukin-12/23 Monoclonal Antibody for the Treatment of Psoriasis

Thu, 08Â FebÂ 2007 00:00:00 -05:00

Background: Skin-infiltrating lymphocytes expressing type 1 cytokines have been linked to the pathophysiology of psoriasis. We evaluated the safety and efficacy of a human interleukin-12/23 monoclonal antibody in treating psoriasis.

Methods:...

CLINICAL PROBLEM-SOLVING: Anchors Away

Thu, 01Â FebÂ 2007 00:00:00 -05:00

A 50-year-old Asian woman presented with a papulonodular, erythematous rash on her legs below the knees. The skin lesions were nontender and nonpruritic and were accompanied by paresthesias. She had...

IMAGES IN CLINICAL MEDICINE: Phlegmasia Cerulea Dolens

Kalleen Barham, M.D. and Tina Shah, M.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

An 85-year-old woman with newly diagnosed metastatic nonâsmall-cell lung cancer was admitted for pain control. Two days after admission, bluish discoloration of the left great toe was noted. Doppler ultrasonography...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2007 â A 49-Year-Old Woman with a Pigmented Lesion on the Arm

John F. Thompson, M.D., F. Stephen Hodi, M.D., and Artur Zembowicz, M.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

A 49-year-old woman was seen in the outpatient surgical clinic of this hospital because of a diagnosis of melanoma.

The patient had noted a flat, pigmented lesion on her left upper...

IMAGES IN CLINICAL MEDICINE: Livedo Reticularis and Cold Agglutinins

Teresa Kauke, M.D. and Armin J. Reininger, M.D., Ph.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

A previously healthy 56-year-old woman had spontaneous eruption of a lacy, net-like erythema of her entire skin, which was especially pronounced on her arms and legs (Panel A). The erythema...

IMAGES IN CLINICAL MEDICINE: Benign Diffuse Breast Hyperplasia during Pregnancy

Shikha Pasrija, M.D. and Nayantara Sharma, M.D. — Thu, 28Â DecÂ 2006 00:00:00 -05:00

A 24-year-old woman, para 2, who was 36 weeks pregnant, presented with massive diffuse enlargement of both breasts, which had progressed since conception (Panel A). There had been no such...

IMAGES IN CLINICAL MEDICINE: Disseminated Paracoccidioidomycosis and Coinfection with HIV

Gleusa Castro, M.D. and Roberto Martinez, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

A 32-year-old man infected with the human immunodeficiency virus (HIV) who had a CD4 count of 9 cells per cubic millimeter had a 9-month history of weight loss, with progressive...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2006 â A 5-Year-Old Boy with Headache and Abdominal Pain

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Dr. Kerstin Zanger (Pediatrics): A 5-year-old boy was admitted to the hospital because of headache, abdominal pain that had increased in severity and frequency, increasing abdominal girth, and a rash.

The...

IMAGES IN CLINICAL MEDICINE: Bisphosphonate-Associated Contact Stomatitis

Pietro Rubegni, M.D. and Michele Fimiani, M.D. — Thu, 30Â NovÂ 2006 00:00:00 -05:00

A 68-year-old woman with severe postmenopausal osteoporosis was referred because of a 6-month history of erosive mucositis of the hard palate, accompanied by intense pain and dysphagia. The patient had...

IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma with Pericardial Metastases

Pierre Boukhalil, M.D. and Ali Debek, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

A 78-year-old woman presented with dyspnea, cough, and a pleural effusion on the left side. She had fractured a hip 3 years earlier, and a chronic decubitus ulcer developed while...

IMAGES IN CLINICAL MEDICINE: Minocycline-Induced Hyperpigmentation

Adrian N. Holm, M.D. and Wayne K. Nelson, M.D. — Thu, 16Â NovÂ 2006 00:00:00 -05:00

An 89-year-old woman presented with a nonhealing ulcer on her right leg. She was taking 100 mg of minocycline orally twice a day as suppressive therapy for a corynebacterium infection...

IMAGES IN CLINICAL MEDICINE: Necrobiosis Lipoidica Diabeticorum

Nicole Wake, B.A. and James C. Fang, M.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 52-year-old man with diabetes reported a 3-month history of a pretibial rash during a routine visit. He had a 15-year history of type 2 diabetes mellitus treated with insulin...

REVIEW ARTICLE: Pemphigus, Bullous Impetigo, and the Staphylococcal Scalded-Skin Syndrome

John R. Stanley, M.D., and Masayuki Amagai, M.D., Ph.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

Pemphigus, which is caused by autoantibodies, and bullous impetigo (including its generalized form, the staphylococcal scalded-skin syndrome), which is caused by Staphylococcus aureus, are seemingly unrelated diseases. However, 200 years...

ORIGINAL ARTICLE: Treatment of Pemphigus Vulgaris with Rituximab and Intravenous Immune Globulin

Thu, 26Â OctÂ 2006 00:00:00 -05:00

Background: Pemphigus vulgaris is a potentially fatal autoimmune mucocutaneous blistering disease. Conventional therapy consists of high-dose corticosteroids, immunosuppressive agents, and intravenous immune globulin.

Methods: We studied patients with refractory pemphigus vulgaris...

IMAGES IN CLINICAL MEDICINE: Yellow Palms and Soles in Diabetes Mellitus

Jiun-Nong Lin, M.D. — Thu, 05Â OctÂ 2006 00:00:00 -05:00

A 55-year-old man presented with a 1-month history of yellow discoloration of his palms and soles (arrow, right palm, as compared with a normal palm to the left). Diabetes mellitus...

IMAGES IN CLINICAL MEDICINE: Plantar Melanoma â A False Vegetant Wart

Vincenzo De Giorgi, M.D. and Daniela Massi, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

A 53-year-old woman was referred to a dermatologist because of a verrucous nodule on the sole of her right foot (Panels A and B) that had been treated as a...

EDITORIAL: Sentinel-Node Biopsy in Melanoma

Charles M. Balch, M.D., and Natale Cascinelli, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

In this issue of the Journal, Morton and colleagues report the largest and most important trial of sentinel-lymph-node biopsy for melanoma conducted to date.1 In the trial, 1269 patients with...

IMAGES IN CLINICAL MEDICINE: Intratracheal Melanoma Metastases

Aditya Bardia, M.D., M.P.H. and Ravi D. Rao, M.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

A 42-year-old woman with metastatic melanoma presented with a 1-month history of dyspnea and wheezing. The diagnosis of malignant melanoma had been made 6 years earlier on the basis of...

REVIEW ARTICLE: The Tuberous Sclerosis Complex

Thu, 28Â SepÂ 2006 00:00:00 -05:00

The tuberous sclerosis complex (TSC), a multisystem, autosomal dominant disorder affecting children and adults, results from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (encoding tuberin) (see...

ORIGINAL ARTICLE: Sentinel-Node Biopsy or Nodal Observation in Melanoma

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Background: We evaluated the contribution of sentinel-node biopsy to outcomes in patients with newly diagnosed melanoma.

Methods: Patients with a primary cutaneous melanoma were randomly assigned to wide excision and postoperative...

IMAGES IN CLINICAL MEDICINE: Congenital Erythropoietic Porphyria

Pankaj Madan, M.D. and Prem Vardhan, M.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 32-year-old man presented with severe pain, swelling, and loss of vision in his left eye after excessive exposure to sunlight. He reported multiple, recurrent, discrete blisters developing on sun-exposed...

IMAGES IN CLINICAL MEDICINE: Anthrax of the Cecum

Antoine Ghossain, M.D. — Thu, 31Â AugÂ 2006 00:00:00 -05:00

A 25-year-old man was admitted for pain and distention of the abdomen. He had a three-day history of dizziness, fatigue, myalgia, and mild fever. On physical examination, he was in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2006 â A 41-Year-Old Woman with Painful Subcutaneous Nodules

Thu, 17Â AugÂ 2006 00:00:00 -05:00

A 41-year-old woman was referred to the dermatology clinic of this hospital for evaluation of painful subcutaneous nodules. She had been well until three years earlier, when several painful nodules...

IMAGES IN CLINICAL MEDICINE: Acquired Leukonychia Totalis

Emmanuel S. Antonarakis, M.D. — Thu, 13Â JulÂ 2006 00:00:00 -05:00

A 72-year-old woman with diabetes mellitus, hypertension, and peripheral vascular disease was hospitalized with chest tightness and acute shortness of breath. She reported a four-month history of worsening dyspnea on...

IMAGES IN CLINICAL MEDICINE: Doxycycline-Induced Phototoxicity

Thomas P. Habif, M.D. — Thu, 13Â JulÂ 2006 00:00:00 -05:00

A 32-year-old man consulted his medical care provider in June because of persistent acne. Two months earlier he had been prescribed a benzoyl peroxide wash and doxycycline (100 mg twice...

CLINICAL PRACTICE: Aphthous Ulceration

Crispian Scully, M.D., Ph.D., M.D.S. — Thu, 13Â JulÂ 2006 00:00:00 -05:00

A 20-year-old woman has had recurrent painful mouth ulcers for the past 10 years. She is otherwise healthy and reports no genital or anal ulcers, skin lesions, gastrointestinal or joint...

IMAGES IN CLINICAL MEDICINE: Abdominal Pseudohernia Due to Herpes Zoster

N. Troy Tagg, M.D. and Jack W. Tsao, M.D., D.Phil. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

A vesicular rash of the right T11âT12 dermatomes developed in a 75-year-old man. Four weeks later, as the rash was resolving (Panel A), he noticed a protrusion of the right...

REVIEW ARTICLE: Melanoma

Arlo J. Miller, M.D., Ph.D., and Martin C. Mihm, Jr., M.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

Although melanoma accounts for only 4 percent of all dermatologic cancers, it is responsible for 80 percent of deaths from skin cancer; only 14 percent of patients with metastatic melanoma...

EDITORIAL: Autoantibodies against PDGF Receptor in Scleroderma

Filemon K. Tan, M.D., Ph.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Scleroderma (systemic sclerosis) is characterized by the deposition and accumulation of excessive amounts of collagen and extracellular-matrix molecules, the dysfunction of microvascular endothelial cells, and altered immune tolerance. These interacting...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2006 â A 22-Month-Old Boy with the Rapid Growth of Subcutaneous Nodules

J. Patrick Whelan, M.D., Ph.D., and Artur Zembowicz, M.D., Ph.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Dr. Richard Chou (Rheumatology): A 22-month-old boy was seen in the pediatric rheumatology clinic because of enlarging subcutaneous nodules on the head, legs, and right hand. The patient had been...

IMAGES IN CLINICAL MEDICINE: Acquired Hypertrichosis Lanuginosa

Gerard Lorette, M.D. and Annabel Maruani, M.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

A 68-year-old woman requested medical attention for a sudden increase in hair growth that she had noticed 11 months earlier. She had lost more than 30 kg during this same...

ORIGINAL ARTICLE: Stimulatory Autoantibodies to the PDGF Receptor in Systemic Sclerosis

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: Systemic sclerosis (scleroderma) is characterized by immunologic abnormalities, injury of endothelial cells, and tissue fibrosis. Abnormal oxidative stress has been documented in scleroderma and linked to fibroblast activation. Since...

ORIGINAL ARTICLE: Cyclophosphamide versus Placebo in Scleroderma Lung Disease

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: We conducted a double-blind, randomized, placebo-controlled trial to determine the effects of oral cyclophosphamide on lung function and health-related symptoms in patients with evidence of active alveolitis and scleroderma-related...

IMAGES IN CLINICAL MEDICINE: Cutaneous Metastases of Small-Cell Lung Cancer

Manuel Haro Estarriol, M.D. and Manuel Rubio Goday, M.D. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

A 70-year-old former smoker presented with a history of several weeks of multiple painless cutaneous nodules on his chest wall. He also reported fatigue, weight loss, and cough with blood-tinged...

IMAGES IN CLINICAL MEDICINE: Scrofula

Sakib K. Khalid, M.D. and Omar Jassim, M.D. — Thu, 04Â MayÂ 2006 00:00:00 -05:00

A 39-year-old Zambian man who was visiting the United States presented with a three-week history of a draining neck mass and a three-month history of swelling on the left side...

IMAGES IN CLINICAL MEDICINE: Bird-Mite Infestation

Tak K. Kong, F.R.C.P. and Wing K. To, F.R.C.P.A. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

A 46-year-old woman and her husband had their sleep disturbed by pruritus, waking up to find similar, itchy papular lesions over their finger webs (Panel A), axillae, groins, and buttocks....

CLINICAL PRACTICE: Scabies

Olivier Chosidow, M.D., Ph.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

A 30-year-old man notes diffuse, intense itching. He reports that his girlfriend has the same itching. Examination of the skin reveals interdigital lesions, with small papules, vesicles, and excoriations on...

IMAGES IN CLINICAL MEDICINE: Pellagra-like Dermatitis

Neda Ashourian, M.D. and Nico Mousdicas, M.D. — Thu, 13Â AprÂ 2006 00:00:00 -05:00

Three months after undergoing Roux-en-Y bariatric surgery, a 32-year-old woman presented with glossitis, angular cheilitis, and an erythematous, desquamative dermatitis with a distribution indicative of photosensitivity causing a burning sensation...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Gangrene and Cutaneous Nodules

Stefan Schanz, M.D. and Anja Ulmer, M.D. — Thu, 06Â AprÂ 2006 00:00:00 -05:00

A 62-year-old man presented with a one-month history of digital gangrene affecting the right hand (Panel A). One digit had been partially amputated 20 years before, after an accident. The...

IMAGES IN CLINICAL MEDICINE: Cholesterol Emboli after Coronary Angioplasty

Omar Rana, M.B., B.S. and William McCrea, F.R.C.P. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

A 72-year-old man presented with unstable angina. An urgent cardiac catheterization showed clinically significant disease in the right coronary artery, which was stented. Twelve hours after the procedure, livedo reticularis...

IMAGES IN CLINICAL MEDICINE: Malignant Obstruction of the Superior Vena Cava

Ronak S. Kanani, M.D. and Douglas E. Drachman, M.D. — Thu, 23Â FebÂ 2006 00:00:00 -05:00

A 75-year-old man with a substantial smoking history and stage IV nonâsmall-cell carcinoma of the lung presented with progressive symptoms of cough, hoarseness, and swelling of the face and arms....

EDITORIAL: Autoimmunity and Immunotherapy for Cancer

Henry Koon, M.D., and Michael Atkins, M.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

Adjuvant treatment for patients after resection of high-risk and regionally metastatic melanoma remains suboptimal. Despite the Food and Drug Administration's approval of high-dose interferon alfa-2b, the substantial toxicity of the...

IMAGES IN CLINICAL MEDICINE: Koplik's Spots

Lawrence M. Tierney, Jr., M.D. and Kevin C. Wang, M.D., Ph.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

A 16-year-old, previously healthy boy came to the hospital with a history of fever for several days, nonproductive cough, and coryza. On examination he appeared to be acutely ill; his...

ORIGINAL ARTICLE: Prognostic Significance of Autoimmunity during Treatment of Melanoma with Interferon

Thu, 16Â FebÂ 2006 00:00:00 -05:00

Background: Immunotherapy for advanced melanoma induces serologic and clinical manifestations of autoimmunity. We assessed the prognostic significance of autoimmunity in patients with stage IIB, IIC, or III melanoma who were...

IMAGES IN CLINICAL MEDICINE: Black Hairy Tongue

Andreas Korber, M.D. and Joachim Dissemond, M.D. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

An 85-year-old male cigar smoker with no notable medical history presented with black discoloration and hairy appearance of the tongue, which had lasted for several years. He said he did...

IMAGES IN CLINICAL MEDICINE: Acanthosis Nigricans

Maria Concetta Fargnoli, M.D. and Pasquale Frascione, M.D. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

A 37-year-old man was evaluated because of a two-year history of asymptomatic thickening and darkening of the skin on his axillae (Panel A), neck, face, and arms. The patient had...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Immunosuppression, Skin Cancer, and Ultraviolet A Radiation

John A. Parrish, M.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

Skin cancer is a serious problem in immunosuppressed patients. In these patients, cutaneous cancers are common in areas of the skin that are exposed to the sun, are more aggressive...

IMAGES IN CLINICAL MEDICINE: Pemphigus Foliaceus

Sarah Johnston, M.R.C.P., M.R.C.Path. and Cameron Kennedy, F.R.C.P. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 63-year-old man presented with a nine-year history of relapsing pemphigus foliaceus that had become refractory to therapy. After treatment with plasma exchange and oral corticosteroids, his disease flared in...

CLINICAL PRACTICE: Hirsutism

Robert L. Rosenfield, M.D. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 19-year-old woman seeks care for slowly progressive hair growth. Since high school, she has shaved her upper lip weekly and waxed her abdomen and thighs monthly. Her menstrual periods...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Extensive Ecchymosis

Denis Mulleman, M.D. and Philippe Goupille, M.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

A 71-year-old man was evaluated for severe anemia (hemoglobin level, 7.1 g per deciliter; mean corpuscular volume, 106 Î¼m3), extensive ecchymosis of the lower limbs (Panel A), gingivitis, and hemorrhages...

REVIEW ARTICLE: Basal-Cell Carcinoma

Adam I. Rubin, M.D., Elbert H. Chen, M.D., and DÃ©sirÃ©e Ratner, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

According to the American Cancer Society, skin cancer is the most common cancer, accounting for about half of all cancers in the United States. More than 1 million cases of...

IMAGES IN CLINICAL MEDICINE: Lentigo Maligna

Bernard Noel, M.D. and Nathalie Kunzle, M.D. — Thu, 17Â NovÂ 2005 00:00:00 -05:00

An 81-year-old woman was referred for treatment of two asymmetric, poorly circumscribed pigmented macules on the left cheek. The pigmentation was variegated, ranging from light brown to retiform areas of...

IMAGES IN CLINICAL MEDICINE: Cetuximab-Associated Acneiform Eruption

Jeremy E. Moss, M.D., Ph.D. and Barbara Burtness, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

A 48-year-old man who has metastatic colon cancer was treated with intravenous fluorouracil, leucovorin, oxaliplatin, and cetuximab, which is a monoclonal antibody to the epidermal growth factor receptor (EGFR). He...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2005 â A 10-Year-Old Girl with a Bullous Skin Eruption and Acute Respiratory Failure

Robert L. Sheridan, M.D., Vincent Liu, M.D., and Sudha Anupindi, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

A 10-year-old girl was transferred to the Shriners Hospital for Children because of a bullous skin eruption, with sloughing of the skin and respiratory failure.

The patient had been well until...

IMAGES IN CLINICAL MEDICINE: Breast Cancer of an Accessory Nipple

Leah S. Gendler, M.D. and Kathie-Ann Joseph, M.D., M.P.H. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

A 42-year-old woman presented to the breast clinic with a mass posterior to an accessory nipple (arrow) that had been progressively enlarging over the past year. On physical examination, the...

IMAGES IN CLINICAL MEDICINE: Left Sixth Cranial Nerve Palsy with Herpes Zoster Ophthalmicus

Edward Jude, M.D., M.R.C.P. and Amiya Chakraborty, M.R.C.P. — Thu, 20Â OctÂ 2005 00:00:00 -05:00

A 62-year-old man reported acute left retro-orbital pain of one week's duration. Physical examination revealed no abnormalities. Three days later, double vision developed, and the next day a rash appeared...

EDITORIAL: Acute Lung Injury â Affecting Many Lives

Margaret S. Herridge, M.D., M.P.H., and Derek C. Angus, M.D., M.P.H. — Thu, 20Â OctÂ 2005 00:00:00 -05:00

Acute lung injury is the clinical syndrome of rapid-onset bilateral pulmonary infiltrates and hypoxemia of noncardiac origin. When the hypoxemia is severe, the condition is termed the acute respiratory distress...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2005 â A 60-Year-Old Man with Skin Lesions and Renal Insufficiency

Jonathan Kay, M.D., and Robert T. McCluskey, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 60-year-old man was evaluated in the rheumatology clinic because of a rash and worsening renal function.

He had been well until three months earlier, when he began to have fatigue...

IMAGES IN CLINICAL MEDICINE: Hemorrhagic Cellulitis after Consumption of Raw Oysters

Lara M. Falcon, M.D. and Lan Pham, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 52-year-old man from southern Louisiana with a history of nonalcoholic steatohepatitis presented to the emergency room with a report of severe bilateral lower-leg pain and swelling. He had ingested...

IMAGES IN CLINICAL MEDICINE: Cullen's and Turner's Signs

Farouk Mookadam, M.D. and Maja Cikes, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

A 72-year-old man with unstable angina was admitted to the hospital. On the sixth day of heparin therapy, the hemoglobin level decreased from 11.7 to 9.4 g per deciliter. On...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2005 â A 68-Year-Old Man with Periorbital Swelling, Rash, and Weakness

Thu, 22Â SepÂ 2005 00:00:00 -05:00

A 68-year-old man was admitted to the hospital because of a rash and muscle weakness.

He had been well until two weeks earlier, when, shortly after returning from a trip to...

IMAGES IN CLINICAL MEDICINE: Pseudomonas Cellulitis

Thomas P. Habif, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

A healthy 42-year-old man presented with a broad eroded, ulcerated lesion on the left foot, which had developed over the previous month. His new job required that he wear boots,...

IMAGES IN CLINICAL MEDICINE: Mixed Cryoglobulinemia

Gary Josephsen, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

A 38-year-old woman presented with increasing abdominal fullness and a new rash on the lower extremities. She had a history of chronic hepatitis C infection, for which she had been...

IMAGES IN CLINICAL MEDICINE: Bortezomib-Induced Skin Lesions

MariÃ«tte J. Agterof, M.D. and Douwe H. Biesma, M.D., Ph.D. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

A 62-year-old woman had progression of multiple myeloma despite many therapies, including an autologous hematopoietic stem-cell transplantation. Infusions of bortezomib (1.3 mg per square meter of body-surface area) were administered...

IMAGES IN CLINICAL MEDICINE: Myiasis Due to (Human Botfly)

Francisco M. Marty, M.D. and Kristen R. Whiteside, B.S. — Thu, 09Â JunÂ 2005 00:00:00 -05:00

A 65-year-old man presented with skin lesions on his chest and left arm and shoulder six weeks after returning from a vacation in Belize at the beach and in the...

CLINICAL PRACTICE: Atopic Dermatitis

Hywel C. Williams, Ph.D. — Thu, 02Â JunÂ 2005 00:00:00 -05:00

A 10-year-old girl with atopic dermatitis reports itching that has recently become relentless, resulting in sleep loss. Her mother has been reluctant to treat the girl with topical corticosteroids, because...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2005 â A 38-Year-Old Man with Fever and Blurred Vision

Thu, 12Â MayÂ 2005 00:00:00 -05:00

A 38-year-old man was admitted to this hospital because of blurred vision and fever.

The patient had ulcerative colitis but had been well while receiving treatment with mercaptopurine and balsalazide until...

IMAGES IN CLINICAL MEDICINE: Scrotal Cancer

Thomas Schwaab, M.D., Ph.D. and Ajay K. Nangia, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

A 63-year-old man with generalized vitiligo presented with a two-year history of irritation and itching in his scrotal area. No ultraviolet treatment for the vitiligo had been received. Physical examination...

REVIEW ARTICLE: Psoriasis

Michael P. SchÃ¶n, M.D., and W.-Henning Boehncke, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

Psoriasis, a common inflammatory skin disorder, has received attention as a target for new pathogenesis-oriented biologic therapies. In this article, we review the genetic, clinical, and pathogenic aspects of psoriasis...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2005 â A 48-Year-Old Man with Weakness of the Limbs and Multiple Tumors of Spinal Nerves

Thu, 28Â AprÂ 2005 00:00:00 -05:00

A 48-year-old, right-handed man was evaluated in the neurology clinic of this hospital because of weakness of his arms and legs.

When the patient was 18 years of age, a mass...

IMAGES IN CLINICAL MEDICINE: Von Recklinghausen's Disease and Breast Cancer

Juan G. Posada, M.D. and Carl G. Chakmakjian, D.O. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

A 74-year-old woman with a history of von Recklinghausen's disease presented with infiltrating lobular carcinoma of the left breast (T2N0M0 [stage IB], according to the tumorânodeâmetastasis [TNM] staging system). On...

IMAGES IN CLINICAL MEDICINE: Disseminated Gonococcal Infection

Stephan Russ, M.D. and Keith Wrenn, M.D. — Thu, 21Â AprÂ 2005 00:00:00 -05:00

A 23-year-old woman with a one-week history of swelling and pain in her right third finger (Panel A, arrow) was seen by an orthopedist, who prescribed cephalexin and indomethacin for...

IMAGES IN CLINICAL MEDICINE: StevensâJohnson Syndrome

Jordan D. Fein, M.D. and Kendal L. Hamann, M.D. — Thu, 21Â AprÂ 2005 00:00:00 -05:00

A 22-year-old woman with a history of a seizure disorder presented to the emergency department after having a rash for three days and a fever for one day. The rash...

CLINICAL PRACTICE: Acne

William D. James, M.D. — Thu, 07Â AprÂ 2005 00:00:00 -05:00

A 17-year-old boy with a six-month history of acne presents for initial evaluation and treatment. Physical examination reveals closed and open comedones and a large number of erythematous papules and...

IMAGES IN CLINICAL MEDICINE: Acquired Acrodermatitis Enteropathica

Linda C. Wang, M.D., J.D. and Shail Busbey, M.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

A 41-year-old woman with a history of alcohol abuse, hypertension, and type 1 diabetes mellitus complicated by retinopathy, nephropathy, and end-stage renal disease presented with a five-month history of alopecia...

IMAGES IN CLINICAL MEDICINE: Marjolin's Ulcer

Albert J. Chong, M.D. and Matthew B. Klein, M.D. — Thu, 10Â MarÂ 2005 00:00:00 -05:00

A 33-year-old man who had sustained a burn injury to his left upper arm as a child presented with a rapidly growing, fungating ulcer in the burn scar. A biopsy...

IMAGES IN CLINICAL MEDICINE: Dermopathy of Graves' Disease

Shih-Ping Cheng, M.D. and Chien-Liang Liu, M.D. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

A 51-year-old woman presented with weight loss (despite good appetite), palpitations, tremor, and heat intolerance. On examination, she had typical features of Graves' disease, including a diffusely enlarged thyroid, periorbital...

CLINICAL PRACTICE: Rosacea

Frank C. Powell, F.R.C.P.I. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

A 47-year-old white woman reports facial redness and flushing. Her eyes are itchy and irritated. She thinks she may have rosacea and is worried that she will have a âwhiskey...

IMAGES IN CLINICAL MEDICINE: Tinea Circinata

Kimberly A. Rovansek, M.D. and Anthony Papadopolous, M.D. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

A 46-year-old woman with a history of infection with the human immunodeficiency virus (HIV) presented to the emergency department for evaluation of a painful rash. The CD4 cell count was...

IMAGES IN CLINICAL MEDICINE: Condylomata Lata of Secondary Syphilis

Josip Begovac, M.D., Ph.D. and Davorka Lukas, M.D., Ph.D. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

A 34-year old bisexual man with newly diagnosed human immunodeficiency virus type 1 (HIV-1) infection presented with a one-month history of anal and oral lesions. He recalled having had a...

REVIEW ARTICLE: Bites of Brown Recluse Spiders and Suspected Necrotic Arachnidism

David L. Swanson, M.D., and Richard S. Vetter, M.S. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

Cutaneous injury caused by spider venom has been recognized by physicians in the United States only since the late 1950s, with recluse spiders (genus loxosceles) most frequently implicated. During the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2005 â A 35-Year-Old Man with Nasal Congestion, Swelling, and Pain

Peter F. Weller, M.D., Marlene L. Durand, M.D., and Ben Z. Pilch, M.D. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

A 35-year-old man presented to the emergency department of this hospital because of nasal congestion, swelling, and pain in his right nostril.

He had been in his usual state of health...

IMAGES IN CLINICAL MEDICINE: Growing Plaque on the Foot

Bryan E. Anderson, M.D. and Elizabeth Billingsley, M.D. — Thu, 03Â FebÂ 2005 00:00:00 -05:00

A 64-year-old woman presented to our clinic with a 20-year history of a slowly growing plaque on her left foot. This lesion had been pared and a biopsy reportedly performed...

IMAGES IN CLINICAL MEDICINE: Tacrolimus Ointment, Alcohol, and Facial Flushing

Jann LÃ¼bbe, M.D. and Maria Milingou, M.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

A 56-year-old patient was treated with 0.1 percent tacrolimus ointment because of rosacea that had been aggravated by prolonged use of topical corticosteroids. After two weeks of treatment, she had...

IMAGES IN CLINICAL MEDICINE: Cylindroma

Rabih A. Chaer, M.D. and Stuart Lipnick, M.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

A 48-year-old man presented to the emergency department with acute bleeding from a chronic scalp tumor. He had a âunicorn-likeâ growth that had been slowly increasing in size for several...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2004 â A 68-Year-Old Man with End-Stage Renal Disease and Thickening of the Skin

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Dr. Amin Fazeli (Dermatology): A 68-year-old man was evaluated in this hospital by a dermatologist because of progressive thickening of the skin of the arms and legs.

The patient had had...

IMAGES IN CLINICAL MEDICINE: Scleromyxedema

Stefan Schanz, M.D. and Gerhard Fierlbeck, Ph.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

A 70-year-old patient presented with a one-year history of progressive tightening of the skin. Physical examination showed generalized sclerodermoid induration and discoloration of the skin (Panel A), as well as...

REVIEW ARTICLE: Intermediate Filament Proteins and Their Associated Diseases

Thu, 11Â NovÂ 2004 00:00:00 -05:00

The cytoskeleton consists of three abundant families of fibrillary proteins: microfilaments, microtubules, and intermediate filaments.12 Intermediate filament proteins derive their name from their diameter, which is intermediate between the diameters...

IMAGES IN CLINICAL MEDICINE: Beau's Lines

Neil J. Mortimer, M.R.C.P. and Jamie Mills, M.R.C.P. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

A 62-year-old woman received six cycles of docetaxel chemotherapy during a six-month period for recurrent metastatic breast cancer. She had completed treatment four weeks before this photograph was taken. Six...

IMAGES IN CLINICAL MEDICINE: A Brilliant Case of Erythrasma

Scott D. Miller, M.D. and Kathleen David-Bajar, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

A 61-year-old man presented with a reddish brown rash in his groin; he had had the rash for more than 30 years and described it as mildly pruritic. After the...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Hyperpigmentation

Scott C. Wickless, D.O. and Tor A. Shwayder, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

A 16-year-old boy presented with a two-year history of hyperpigmentation of the skin; his sclera were unaffected. He is shown with his mother for comparison. What is the diagnosis?...

CLINICAL PROBLEM-SOLVING: Footprints

Sigall Kassutto, M.D., and Johanna P. Daily, M.D. — Thu, 30Â SepÂ 2004 00:00:00 -05:00

A 42-year-old woman with a history of asthma and the irritable bowel syndrome presented with pain and swelling of her feet and ankles that were associated with a rash on...

REVIEW ARTICLE: Management of Cutaneous Melanoma

Hensin Tsao, M.D., Ph.D., Michael B. Atkins, M.D., and Arthur J. Sober, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

04090228.xml 04090228.xml 04090228.xml 04090228.xml Cutaneous melanoma remains a management challenge. The National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database documents increases of 619 percent in annual diagnoses...

IMAGES IN CLINICAL MEDICINE: Tenosynovitis Due to

Roxann Powers, M.D. and Melanie Fisher, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

A healthy 60-year-old woman presented with a painful left hand. She noted that she had pulled a splinter from her left thumb while on vacation three months previously. She reported...

IMAGES IN CLINICAL MEDICINE: HenochâSchÃ¶nlein Purpura

Mark A. Marinella, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

A 20-year-old man was admitted to the hospital with a one-day history of fever and acute, painful symmetric polyarthritis that involved the wrists, elbows, and ankles. During the next two...

IMAGES IN CLINICAL MEDICINE: Vitiligo and Pernicious Anemia

Fritz Egli, M.D. and Roland Walter, M.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

A 45-year-old woman with a 17-year history of vitiligo (panel A) was evaluated because of persistent fatigue. She was found to have pancytopenia (white-cell count, 3200 per cubic millimeter; hemoglobin...

ORIGINAL ARTICLE: Treatment of Skin Papillomas with Topical Î±-LactalbuminâOleic Acid

Thu, 24Â JunÂ 2004 00:00:00 -05:00

Background: We studied the effect on skin papillomas of topical application of a complex of Î±-lactalbumin and oleic acid (often referred to as human Î±-lactalbumin made lethal to tumor cells...

PERSPECTIVE: Milk of Human Kindness? â HAMLET, Human Papillomavirus, and Warts

Jan N. Bouwes Bavinck, M.D., Ph.D., and Mariet C.W. Feltkamp, M.D., Ph.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Cutaneous viral warts are common, benign, usually self-limited papillomas with a preference for the hands and feet. A wide range of local therapies based on destruction, keratolysis, immunostimulation, or antimitotic...

IMAGES IN CLINICAL MEDICINE: Radiation Injury from a Fluoroscopic Procedure

Lesley Wong, M.D. and Jason Rehm, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

A 52-year-old man underwent an ablative procedure for supraventricular arrhythmias, and a painful ulceration developed on the posterior surface of his right arm four months later. His arm had accidentally...

IMAGES IN CLINICAL MEDICINE: Dislocation of the Lenses

Sameer K. Mathur, M.D., Ph.D. and Daniel Grodinsky, M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

A 60-year-old man with a history of frequent falls presented after a fall that resulted in minor trauma to the head. A review of systems was remarkable only for the...

IMAGES IN CLINICAL MEDICINE: Infestation

Nicholas N. Stoffle, B.S. and Philip R. Cohen, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

A 24-year-old man and his fiancÃ©e had pruritus of two months' duration. They had similar skin lesions, with burrows on the webs between their fingers. A specimen obtained from scrapings...

REVIEW ARTICLE: The Pathogenesis of Mycosis Fungoides

Michael Girardi, M.D., Peter W. Heald, M.D., and Lynn D. Wilson, M.D., M.P.H. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

Cutaneous T-cell lymphoma represents a complex array of disorders with various manifestations, clinical courses, and therapeutic considerations. Mycosis fungoides â in which the skin is variably affected by flat patches,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2004 â A Newborn Girl with a Large Cutaneous Lesion, Thrombocytopenia, and Anemia

Thu, 22Â AprÂ 2004 00:00:00 -05:00

A newborn girl was transferred to this hospital because of a large cutaneous lesion, thrombocytopenia, and anemia.

The infant had been born at another hospital to a 33-year-old woman (gravida 2,...

IMAGES IN CLINICAL MEDICINE: A Complication of Cosmetic Surgery

So Young Moon, M.D. and Gregory Youngnam Chang, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 45-year-old woman who had received local anesthesia underwent injection of abdominal subcutaneous fat into the vertical glabellar frown lines to remove wrinkles. Within a minute after the procedure, she...

CLINICAL PRACTICE: Treatment of Photoaging

Robert S. Stern, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 45-year-old fair-skinned woman has noted increasing sallowness, roughness, fine wrinkles, and mottled hyperpigmentation on her face. She is bothered by these changes and is worried about the development of...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Painless Ulcers

Stephen Morris-Jones, M.R.C.P. and Martin Weber, M.D. — Thu, 01Â AprÂ 2004 00:00:00 -05:00

A 23-year-old Peace Corps volunteer lived in a traditional mud hut with a thatched roof in a rural savannah village in Gambia. Several painless ulcers developed on his lower legs...

IMAGES IN CLINICAL MEDICINE: Angiomatosis Associated with Sneddon's Syndrome

Josef G. Heckmann, M.D. and M. LÃ¼fti, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

A 34-year-old woman was admitted for acute right hemiparesis, which resolved within 24 hours. She had no history of hypertension, diabetes, migraine, or smoking. Since early childhood, she had had...

IMAGES IN CLINICAL MEDICINE: Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

Keshav R. Nayak, M.D. and Richard G. Daly, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

A previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso...

IMAGES IN CLINICAL MEDICINE: Interdigital Pilonidal Sinus

Peter J. Stern, M.D. and Charles A. Goldfarb, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

A healthy 39-year-old woman who was employed as an animal groomer presented with a chronic draining cyst in the web between the middle and ring fingers of one hand. The...

IMAGES IN CLINICAL MEDICINE: Oculo-Orogenital Syndrome â A Deficiency of Vitamins B and B

AndrÃ© Friedli, M.D. and Jean-Hilaire Saurat, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

A 48-year-old man presented with a six-month history of irritated mouth angles, irritated genital skin, and red, burning eyes. On physical examination, he had blepharoconjunctivitis (Panel A), angular stomatitis (Panel...

CLINICAL PRACTICE: Photosensitivity

Warwick L. Morison, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

A 30-year-old white woman has a 72-hour history of a pruritic rash on her arms and chest. This is the third episode of the rash this summer, and each episode...

IMAGES IN CLINICAL MEDICINE:

Chau Nguyen, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

A small, raised, erythematous lesion developed on the dorsum of the hand of a 35-year-old man who worked in a pet shop. Over a period of three months, there was...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2004 â A 48-Year-Old Woman with Multiple Pigmented Lesions and a Personal and Family History of Melanoma

Thu, 26Â FebÂ 2004 00:00:00 -05:00

A 48-year-old woman was evaluated in the clinic because of multiple pigmented skin lesions and a personal and family history of melanoma.

When the patient was 30 years old, a superficial...

CLINICAL PRACTICE: Cellulitis

Morton N. Swartz, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

An otherwise healthy 40-year-old man felt feverish and noted pain and redness over the dorsum of his foot. Tender edema and erythema extended up the pretibial area. Fissures were present...

EDITORIAL: Defining Adequate Surgery for Primary Melanoma

Susan E. Krown, M.D., and Paul B. Chapman, M.D. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

The incidence of malignant melanoma has been rising over the past three decades.1 Much of the increase is accounted for by thin, localized cutaneous melanomas with the potential to be...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2004 â A 35-Year-Old Woman with Extensive, Deep Burns from a Nightclub Fire

Thu, 19Â FebÂ 2004 00:00:00 -05:00

A 35-year-old woman sustained extensive burns and was possibly trampled in a nightclub after a pyrotechnics display set fire to the building. At the scene, she was responsive but confused...

IMAGES IN CLINICAL MEDICINE: Ocular Melanocytosis

James Chodosh, M.D. and Russell D. Burris — Thu, 19Â FebÂ 2004 00:00:00 -05:00

A nine-year-old girl presented for evaluation of hyperpigmentation of her left eye (Panel A). The condition had been present since birth. The visual acuity was 20/20 in each eye. Slit-lamp...

ORIGINAL ARTICLE: Excision Margins in High-Risk Malignant Melanoma

Thu, 19Â FebÂ 2004 00:00:00 -05:00

Background: Controversy exists concerning the necessary margin of excision for cutaneous melanoma 2 mm or greater in thickness.

Methods: We conducted a randomized clinical trial comparing 1-cm and 3-cm margins.

Results Of...

IMAGES IN CLINICAL MEDICINE: Use of Multinucleated Giant Cells to Diagnose a Viral Eruption

Frank C. Koranda, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

Part of the differential diagnosis of a vesicular eruption must include smallpox. The characteristic smallpox lesions â papulovesicular pustules â develop two to four days after an influenza-like prodrome. The...

ORIGINAL ARTICLE: Tanapox Infection in a College Student

Thu, 22Â JanÂ 2004 00:00:00 -05:00

Tanapox infection is a poxvirus infection that is endemic to equatorial Africa. It begins with a febrile prodrome that is soon followed by the eruption of one or more large,...

ORIGINAL ARTICLE: The Detection of Monkeypox in Humans in the Western Hemisphere

Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Putting the Brakes on Cylindromatosis?

Sunil R. Lakhani, M.D. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

In patients with familial cylindromatosis, or âturban tumors,â numerous benign skin adnexal tumors develop, principally on the head and neck (Figure 1). This rare disorder is caused by a mutation...

ORIGINAL ARTICLE: Use of an AntiâInterleukin-5 Antibody in the Hypereosinophilic Syndrome with Eosinophilic Dermatitis

Thu, 11Â DecÂ 2003 00:00:00 -05:00

The hypereosinophilic syndrome comprises a heterogeneous group of conditions characterized by hypereosinophilia and organ dysfunction caused by eosinophil-mediated tissue damage.12 The highly variable response to treatment reflects the heterogeneity of...

CLINICAL PRACTICE: Dysplastic Nevi

Jean Marie Naeyaert, M.D., Ph.D., and Lieve Brochez, M.D., Ph.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

A 26-year-old man comes to establish primary care. Physical examination reveals multiple moles on his body, which he describes as âfunny-looking.â There is no family history of melanoma. He thinks...

IMAGES IN CLINICAL MEDICINE: Fabry's Disease

Jeffrey B. Kopp, M.D. and Raphael Schiffmann, M.D. — Thu, 20Â NovÂ 2003 00:00:00 -05:00

A 30-year-old man had severe neuropathic pain that affected his hands and feet. Examination of his skin showed angiokeratomas that were particularly prominent in the groin and on the back...

ORIGINAL ARTICLE: Etanercept as Monotherapy in Patients with Psoriasis

Thu, 20Â NovÂ 2003 00:00:00 -05:00

Background: Inflammatory cytokines such as tumor necrosis factor (TNF) have been implicated in the pathogenesis of psoriasis. We evaluated the safety and efficacy of etanercept, a TNF antagonist, for the...

ORIGINAL ARTICLE: A Novel Targeted T-Cell Modulator, Efalizumab, for Plaque Psoriasis

Thu, 20Â NovÂ 2003 00:00:00 -05:00

Background: Interactions between leukocyte-functionâassociated antigen type 1 (LFA-1) and intercellular adhesion molecules are important in the pathogenesis of psoriasis. Efalizumab, a humanized monoclonal antibody, binds to the Î± subunit (CD11a)...

PERSPECTIVE: Immunologic Targets in Psoriasis

Thomas S. Kupper, M.D. — Thu, 20Â NovÂ 2003 00:00:00 -05:00

In this issue of the Journal, two reports present data on the efficacy of two new biologic drugs for psoriasis. One of these drugs, etanercept, has been used extensively in...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Nicholas Magee, M.R.C.P. and Rory Convery, M.R.C.P. — Thu, 25Â SepÂ 2003 00:00:00 -05:00

A 48-year-old woman had a 30-year history of dermatomyositis treated with prednisolone. She was admitted for depression and nausea. Examination revealed multiple craggy skin nodules, shown on the right flank...

IMAGES IN CLINICAL MEDICINE: Human Bites versus Dog Bites

Howard Fischer, M.D., Pamela W. Hammel, D.D.S., and L.J. Dragovic, M.D. — Thu, 11Â SepÂ 2003 00:00:00 -05:00

A six-year-old boy was admitted to the hospital with an acute abdomen. He had a rectal perforation and two groups of lesions on his right leg. Neither he nor his...

IMAGES IN CLINICAL MEDICINE: The Harlequin Color Change

Jaggi Rao, M.D. and Alfons Krol, M.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

On the third day of life, balloon dilatation of the pulmonary valve was performed in a full-term newborn with pulmonary atresia. Eight days later, asymptomatic, macular, blanchable erythema developed, involving...

ORIGINAL ARTICLE: Methotrexate versus Cyclosporine in Moderate-to-Severe Chronic Plaque Psoriasis

Thu, 14Â AugÂ 2003 00:00:00 -05:00

Background: Methotrexate and cyclosporine are well-known systemic therapies for moderate-to-severe chronic plaque psoriasis. We conduced a randomized, controlled trial comparing methotrexate and cyclosporine in terms of effectiveness, side effects, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2003 â A 79-Year-Old Woman with Gastric Lymphoma and Erosive Mucosal and Cutaneous Lesions

A. Razzaque Ahmed, M.D., Mathew M. Avram, M.D., J.D., and Lyn M. Duncan, M.D. — Thu, 24Â JulÂ 2003 00:00:00 -05:00

A 79-year-old woman with a gastric B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type was admitted to the hospital because of erosive mucosal and cutaneous lesions.

The patient had been...

IMAGES IN CLINICAL MEDICINE: Phytosterolemia and Xanthomatosis

Anton F. Stalenhoef,, M.D., Ph.D. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

A 17-year-old girl presented with multiple xanthomas of the hands (Panel A) and the Achilles tendons, as well as a family history of vascular disease. Familial hypercholesterolemia was suspected, but...

REVIEW ARTICLE: Skin Cancers after Organ Transplantation

Sylvie Euvrard, M.D., Jean Kanitakis, M.D., and Alain Claudy, M.D. — Thu, 24Â AprÂ 2003 00:00:00 -05:00

Long-term survival after organ transplantation is increasing. As a result, many physicians may encounter patients who have long-term complications of transplantation. Adequate graft function requires lifelong immunosuppressive treatment, and the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2003 â A 16-Year-Old Girl with a Rash and Chest Pain

Ivor Caro, M.D., and Artur Zembowicz, M.D. — Thu, 13Â FebÂ 2003 00:00:00 -05:00

A 16-year-old girl was admitted to the hospital because of pleuritic chest pain.

Bilateral imbrication of the hip capsules had been performed 15 months earlier at this hospital because of recurrent...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2002 â A 69-Year-Old Man with Painful Cutaneous Nodules, Elevated Lipase Levels, and Abnormal Results on Abdominal Scanning

Stanley W. Ashley and Gregory Y. Lauwers — Thu, 28Â NovÂ 2002 00:00:00 -05:00

A 69-year-old man was admitted to the hospital because of painful cutaneous nodules, elevated lipase levels, and abnormal results on abdominal scanning.

The patient had been in stable health until 15...

ORIGINAL ARTICLE: Two Patients with Unusual Forms of VaricellaâZoster Virus Vasculopathy

Thu, 07Â NovÂ 2002 00:00:00 -05:00

Infection of cerebral arteries by varicellaâzoster virus (VZV) can produce unifocal or multifocal vasculopathy. Unifocal large-vessel vasculopathy (granulomatous arteritis) usually affects elderly immunocompetent persons, whereas multifocal vasculopathy occurs primarily in...

IMAGES IN CLINICAL MEDICINE: Atypical Pyoderma Gangrenosum in a Splenectomy Incision

Pareshkumar Patel, M.D. and Arthur Topilow, M.D. — Thu, 31Â OctÂ 2002 00:00:00 -05:00

Figure 1. A 72-year-old woman underwent splenectomy for transfusion-dependent myelofibrosis, and rapidly advancing, nonhealing necrotic skin ulcers developed over the incision site on the eighth postoperative day (Panel A). The...

ORIGINAL ARTICLE: Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum

Thu, 31Â OctÂ 2002 00:00:00 -05:00

Background: Pyoderma gangrenosum is a diagnosis of exclusion, and the misdiagnosis of pyoderma gangrenosum can result in substantial complications in patients who have other causes of severe cutaneous ulceration.

Methods: We...

EDITORIAL: Antimicrobial Peptides in Health and Disease

Thu, 10Â OctÂ 2002 00:00:00 -05:00

Microbes surround us. However, most of the time we are unaware of them. Our epithelial surfaces, which provide the physical barrier separating us from the environment, are usually free of...

ORIGINAL ARTICLE: Endogenous Antimicrobial Peptides and Skin Infections in Atopic Dermatitis

Thu, 10Â OctÂ 2002 00:00:00 -05:00

Background: The innate immune system of human skin contains antimicrobial peptides known as cathelicidins (LL-37) and Î²-defensins. In normal skin these peptides are negligible, but they accumulate in skin affected...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2002 â A 48-Year-Old Man with Persistent Erosive Oral Lesions

George T. Gallagher and Stephen Lyle — Thu, 08Â AugÂ 2002 00:00:00 -05:00

A 48-year-old man was admitted to the Ambulatory Disease Service of the Massachusetts Eye and Ear Infirmary because of severe chronic oral lesions.

For several years, the patient had taken ibuprofen...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2002 â A 21-Year-Old Man with Arthritis during Treatment for Hyperthyroidism

Simon M. Helfgott and R. Neal Smith — Thu, 11Â JulÂ 2002 00:00:00 -05:00

A 21-year-old man was admitted to the hospital because of inflammatory lesions of the foot.

The patient had been well until 15 months before admission. At that time, while he was...

IMAGES IN CLINICAL MEDICINE: The Many Faces of Poison Ivy

Gregory Parkinson, M.D. — Thu, 04Â JulÂ 2002 00:00:00 -05:00

Figure 1. Poison ivy (Rhus radicans) is a woody shrub or vine found throughout the United States. Red-tinged leaves grow in groups of three and have smooth, fine-toothed, or lobed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2002 â A 37-Year-Old Man with Fever, Hepatosplenomegaly, and a Cutaneous Foot Lesion after a Trip to Africa

Thu, 27Â JunÂ 2002 00:00:00 -05:00

A 37-year-old man was admitted to the Tropical and Geographic Medicine Center of this hospital because of fever and an inflamed foot.

The patient had been in vigorous health three months...

IMAGES IN CLINICAL MEDICINE: Finger-Pad Tophi

Komal F. Chopra, M.D. and Marc E. Grossman, M.D. — Thu, 30Â MayÂ 2002 00:00:00 -05:00

Figure 1. A 57-year-old man presented with a three-month history of cream-yellow papules of 2 to 3 mm on the pulps of his fingers on both hands (Panel A) and...

CLINICAL PRACTICE: Head Lice

Richard J. Roberts, M.B., B.S., D.C.H., M.P.H. — Thu, 23Â MayÂ 2002 00:00:00 -05:00

An eight-year-old girl is sent home after the school nurse detects head lice. She will not be permitted to return to school until the absence of infestation is documented. What...

ORIGINAL ARTICLE: An Outbreak of Mycobacterial Furunculosis Associated with Footbaths at a Nail Salon

Thu, 02Â MayÂ 2002 00:00:00 -05:00

Background: In September 2000, a physician in northern California described four patients with persistent, culture-negative boils on the lower extremities. The patients had received pedicures at the same nail salon....

IMAGES IN CLINICAL MEDICINE: Eczema Vaccinatum â A Timely Reminder

Allon E. Moses, M.D. and Ronit Cohen-Poradosu, M.D. — Thu, 25Â AprÂ 2002 00:00:00 -05:00

Figure 1. Ten days after being vaccinated against smallpox, a 27-year-old man was hospitalized with a high fever, facial edema, and an umbilicated, vesicular, crusting rash on his face, neck,...

ORIGINAL ARTICLE: Fluconazole for the Treatment of Cutaneous Leishmaniasis Caused by

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Background: Whereas certain oral antifungal azoles are well documented to have activity against leishmania, data on the efficacy of fluconazole for leishmaniasis are limited. We conducted a controlled trial in...

IMAGES IN CLINICAL MEDICINE: Hypercarotenemia

Antonino Mazzone, M.D. and Antonio Dal Canton, M.D. — Thu, 14Â MarÂ 2002 00:00:00 -05:00

Figure 1. A 23-year-old woman who was admitted for jaundice was found to have yellow-orange discoloration of her skin (her hand is shown on the right, and the hand of...

EDITORIAL: Bullous Pemphigoid Therapy â Think Globally, Act Locally

Thu, 31Â JanÂ 2002 00:00:00 -05:00

Until now, systemic immunosuppressive agents, particularly oral corticosteroids, have been the standard treatment for bullous pemphigoid, which accounts for about 75 percent of cases of autoimmune blistering skin disease.123 Nearly...

ORIGINAL ARTICLE: A Comparison of Oral and Topical Corticosteroids in Patients with Bullous Pemphigoid

Thu, 31Â JanÂ 2002 00:00:00 -05:00

Background: Bullous pemphigoid is the most common autoimmune blistering skin disease of the elderly. 02013129.xml Because elderly people have low tolerance for standard regimens of oral corticosteroids, we studied whether...

CLINICAL PRACTICE: Chronic Urticaria and Angioedema

Allen P. Kaplan, M.D. — Thu, 17Â JanÂ 2002 00:00:00 -05:00

A 35-year-old woman presents with a three-month history of daily generalized hives. The hives are pruritic, red wheals that range from 1.5 to 8.0 cm (0.5 to 3 in.) in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2002 â A 24-Year-Old Woman with Paresthesias and Muscle Cramps after a Stay in Africa

Thomas B. Nutman, M.D., and Richard L. Kradin, M.D. — Thu, 10Â JanÂ 2002 00:00:00 -05:00

A 24-year-old woman was admitted to the Travel and Tropical Medicine Center at this hospital because of edema and intermittent paresthesias of the right leg.

The patient was a volunteer with...

IMAGES IN CLINICAL MEDICINE: Pigmentation Related to Amiodarone

Whitney A. High, M.D. and Steven D. Weiss, M.D. — Thu, 15Â NovÂ 2001 00:00:00 -05:00

Figure 1. A 55-year-old man had blue-gray discoloration of the auricular and periauricular areas of his ears. In 1985, he had had a large anterior myocardial infarction during aortic-valve replacement....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2001 â A 54-Year-Old Woman with Multiple Sclerosis, Prolonged Fever, and Skin Nodules

Joseph O. Jacobson and Laurence de Leval — Thu, 08Â NovÂ 2001 00:00:00 -05:00

A 54-year-old woman was admitted to the hospital with fever of unknown origin of one year's duration.

The patient was confined to a bed because of multiple sclerosis of 20 years'...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2001 â A 33-Year-Old Man with a Rash, Pulmonary Infection, and Neurologic Disorder

C. Fordham von Reyn, M.D., and Eugene J. Mark, M.D. — Thu, 25Â OctÂ 2001 00:00:00 -05:00

A 33-year-old man was admitted to the hospital because of leg numbness and back pain.

The patient had been well until six weeks before admission, when pruritus developed on his upper...

EDITORIAL: An Exception to the Rule

Thu, 18Â OctÂ 2001 00:00:00 -05:00

In 1972, the first biochemical abnormality to be identified in a form of the EhlersâDanlos syndrome, a deficiency of lysyl hydroxylase, a collagen-modifying enzyme, was described in the Journal.1 Many...

ORIGINAL ARTICLE: A Recessive Form of the EhlersâDanlos Syndrome Caused by Tenascin-X Deficiency

Thu, 18Â OctÂ 2001 00:00:00 -05:00

Background: The EhlersâDanlos syndrome is a heritable connective-tissue disorder caused by defects in fibrillar-collagen metabolism. Mutations in the type V collagen genes account for up to 50 percent of cases...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2001 â A 70-Year-Old Woman with End-Stage Renal Disease and Cutaneous Ulcers

Daniel T. Baran, M.D., and Gary St.A. Letts, M.D. — Thu, 11Â OctÂ 2001 00:00:00 -05:00

A 70-year-old woman was admitted to the hospital because of dyspnea and multiple cutaneous ulcers.

The patient had a history of long-standing type 2 diabetes mellitus as well as an old...

IMAGES IN CLINICAL MEDICINE: Porphyria Cutanea Tarda

Marianne Cloeren, M.D., M.P.H. and Eugene Craig, M.D. — Thu, 04Â OctÂ 2001 00:00:00 -05:00

Figure 1. A 46-year-old fisherman and Vietnam veteran presented with a recurrent rash on his arms and legs and a painful, swollen area on his left leg of several days'...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2001 â Hypertensive Encephalopathy with Impaired Renal Function in a 67-Year-Old Woman with Polymyositis

Joseph H. Korn, M.D., and Shamila Mauiyyedi, M.D. — Thu, 23Â AugÂ 2001 00:00:00 -05:00

A 67-year-old woman was initially admitted to this hospital because of hypertensive encephalopathy.

The patient had been well until one month before admission, when she became weak and began to have...

ORIGINAL ARTICLE: The Pseudomonas Hot-Foot Syndrome

Thu, 02Â AugÂ 2001 00:00:00 -05:00

Background: Between March and May 1998, there was an outbreak of a clinically distinct skin eruption on the soles of the feet of children who used a community wading pool.

Methods:...

EDITORIAL: New Treatments for Psoriasis

Thu, 26Â JulÂ 2001 00:00:00 -05:00

Psoriasis is an inflammatory skin disorder that affects about 1 to 3 percent of persons throughout the world.1 Although most persons with plaque psoriasis have mild or moderate disease that...

ORIGINAL ARTICLE: Treatment of Chronic Plaque Psoriasis by Selective Targeting of Memory Effector T Lymphocytes

Thu, 26Â JulÂ 2001 00:00:00 -05:00

Background: Psoriatic plaques are characterized by infiltration with CD45RO+ memory effector T lymphocytes. The recombinant protein alefacept binds to CD2 on memory effector T lymphocytes, inhibiting their activation.

Methods: In a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2001 â A 47-Year-Old Woman with Diabetes, Crohn's Colitis, and a Painful Swelling of the Foot

Harley A. Haynes, Fiona M. Graeme-Cook, Lisa H. Lerner — Thu, 10Â MayÂ 2001 00:00:00 -05:00

A 47-year-old woman was admitted to the hospital for the third time because of a painful, red swelling of the right foot.

Nine months before the third admission, the patient had...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Figure 1. This 82-year-old woman was referred to a physician. What is the diagnosis?...

REVIEW ARTICLE: Cutaneous Squamous-Cell Carcinoma

Nonmelanoma skin cancer is the most common cancer in the United States, with over 1.3 million cases expected to occur in the year 2001. Approximately 80 percent of nonmelanoma skin...

IMAGES IN CLINICAL MEDICINE: Lichtenberg Figures Due to a Lightning Strike

Yves Domart, M.D. and Emmanuel Garet, M.D. — Thu, 23Â NovÂ 2000 00:00:00 -05:00

Figure 1. A 54-year-old man was struck by lightning and was initially stuporous. The emergency medical team found him conscious and in sinus rhythm, with normal vital signs and numbness...

EDITORIAL: Pemphigus â Decoding the Cellular Language of Cutaneous Autoimmunity

Thu, 06Â JulÂ 2000 00:00:00 -05:00

The primary causes of the most common autoimmune disorders have been elusive. Pemphigus foliaceus has attracted considerable attention, despite its low incidence, because the associated autoantibodies are directly pathogenic, their...

ORIGINAL ARTICLE: Protection against Pemphigus Foliaceus by Desmoglein 3 in Neonates

Thu, 06Â JulÂ 2000 00:00:00 -05:00

Pemphigus foliaceus is an autoantibody-mediated blistering disease in which antibodies against desmoglein 1 cause loss of adhesion among keratinocytes in the superficial epidermis.1 Desmogleins are transmembrane glycoproteins found in desmosomes,...

ORIGINAL ARTICLE: The Prevalence of Antibodies against Desmoglein 1 in Endemic Pemphigus Foliaceus in Brazil

Thu, 06Â JulÂ 2000 00:00:00 -05:00

Background: Pemphigus foliaceus is an autoimmune skin disease mediated by autoantibodies against desmoglein 1. The endemic form is thought to have an environmental cause. The Terena reservation of LimÃ£o Verde...

IMAGES IN CLINICAL MEDICINE: Bacterial Perianal Dermatitis

Heikki Peltola, M.D. — Thu, 22Â JunÂ 2000 00:00:00 -05:00

Figure 1. A four-year-old boy was seen by the pediatrician because of difficulty sleeping and intense pruritus in the anal region, with a three-day history of local redness in the...

IMAGES IN CLINICAL MEDICINE: Staphylococcal Scalded Skin Syndrome

Louis A. Schenfeld, M.D. — Thu, 20Â AprÂ 2000 00:00:00 -05:00

Figure 1. A six-year-old boy was hospitalized with a rash and fever. He had been well until two days before admission, when general pruritus developed. That evening, small water blisters...

IMAGES IN CLINICAL MEDICINE: Furuncular Myiasis

Meg A. Lemon, M.D. and John L. Aeling, M.D. — Thu, 30Â MarÂ 2000 00:00:00 -05:00

Figure 1. A 46-year-old woman had an enlarging, tender, draining nodule on the upper arm. Prior treatment consisting of hot compresses and a course of oral antibiotics had had no...

IMAGES IN CLINICAL MEDICINE: Varicella Gangrenosa

Javier Tello, M.D. and Juan Bossano, M.D. — Thu, 02Â MarÂ 2000 00:00:00 -05:00

Figure 1. Four days after the onset of symptoms of varicella in a 16-month-old girl, violaceous lesions developed on her neck and trunk that became necrotic and had an erythematous...

IMAGES IN CLINICAL MEDICINE: Cutaneous Zygomycosis (Mucormycosis)

Christopher F. Carpenter, M.D. and Aruna K. Subramanian, M.D. — Thu, 16Â DecÂ 1999 00:00:00 -05:00

Figure 1. A 60-year-old man with diabetes mellitus and advanced cirrhosis underwent orthotopic liver transplantation that was complicated by an intraoperative myocardial infarction. His immunosuppressive regimen included tacrolimus and methylprednisolone,...

REVIEW ARTICLE: Inflammatory Skin Diseases, T Cells, and Immune Surveillance

Caroline Robert, M.D., and Thomas S. Kupper, M.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

Skin is the primary interface between the body and the environment. The spectrum of insults to which skin is susceptible includes disorders caused by chemical and microbial agents, thermal and...

REVIEW ARTICLE: Inflammatory Skin Diseases, T Cells, and Immune Surveillance

Caroline Robert, M.D., and Thomas S. Kupper, M.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

Skin is the primary interface between the body and the environment. The spectrum of insults to which skin is susceptible includes disorders caused by chemical and microbial agents, thermal and...

REVIEW ARTICLE: Treatment of Hair Loss

Vera H. Price, M.D. — Thu, 23Â SepÂ 1999 00:00:00 -05:00

Hair loss is a common and distressing symptom. With the approval of two drugs that promote hair growth â finasteride and minoxidil â we can now treat patients with some...

IMAGES IN CLINICAL MEDICINE: Pulmonary and Disseminated Nocardiosis

Jerry D. Smilack, M.D. — Thu, 16Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 76-year-old man who had taken various doses of corticosteroids and methotrexate for ChurgâStrauss syndrome was seen for anorexia, weakness, and painful âbumpsâ on his scalp. A creamy...

IMAGES IN CLINICAL MEDICINE: Meningitis

Ascension Gonzalez Garcia, M.D. and Rafael Rodriguez Jimenez, M.D. — Thu, 09Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 49-year-old sheep farmer came to us with a necrotic lesion on his chin, with surrounding gelatinous edema (arrow in Panel A), and a three-day history of obtundation....

REVIEW ARTICLE: Cutaneous Wound Healing

Adam J. Singer, M.D., and Richard A.F. Clark, M.D. — Thu, 02Â SepÂ 1999 00:00:00 -05:00

The primary function of the skin is to serve as a protective barrier against the environment. Loss of the integrity of large portions of the skin as a result of...

REVIEW ARTICLE: The Biology of Hair Follicles

Ralf Paus, M.D., and George Cotsarelis, M.D. — Thu, 12Â AugÂ 1999 00:00:00 -05:00

Hair has many useful biologic functions, including protection from the elements and dispersion of sweat-gland products (e.g., pheromones). It also has psychosocial importance in our society, and patients with hair...

IMAGES IN CLINICAL MEDICINE: Homozygous Familial Hypercholesterolemia

Figure 1. A 39-year-old man with homozygous familial hypercholesterolemia because of a GâC mutation at the acceptor-splice site of intron 7 of the low-density lipoprotein (LDL) receptor had undergone coronary-artery...

REVIEW ARTICLE: Hemangiomas in Children

Beth A. Drolet, M.D., Nancy B. Esterly, M.D., and Ilona J. Frieden, M.D. — Thu, 15Â JulÂ 1999 00:00:00 -05:00

Hemangiomas are the most common soft-tissue tumors of infancy, occurring in approximately 5 to 10 percent of one-year-old children. Despite the frequency of these tumors, their pathogenesis is not completely...

ORIGINAL ARTICLE: A Comparison of Injections of Botulinum Toxin and Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure

Thu, 08Â JulÂ 1999 00:00:00 -05:00

Background: and Methods: Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared...

IMAGES IN CLINICAL MEDICINE: Hereditary Hemorrhagic Telangiectasia (OslerâWeberâRendu Disease)

Aryel Nicoleau, M.D. and Carl A. Nicoleau, M.D., Ph.D. — Thu, 10Â JunÂ 1999 00:00:00 -05:00

Figure 1. A 67-year-old woman has multiple telangiectasias on her hands, as well as on her arms, legs, ears, lips, and nasal mucosa. She has had numerous episodes of epistaxis...

IMAGES IN CLINICAL MEDICINE: Argyria

Bruce A. Bouts, M.D. — Thu, 20Â MayÂ 1999 00:00:00 -05:00

Figure 1. A 56-year-old woman has had discolored skin since the age of 14 (Panel A, left, and Panel B). At the age of 11 the patient was given nose...

IMAGES IN CLINICAL MEDICINE: Madelung's Disease: Inherited from an Ancient Mediterranean Population?

Claudio Feliciani, M.D. and Pierluigi Amerio, M.D. — Thu, 13Â MayÂ 1999 00:00:00 -05:00

Figure 1. A 44-year-old man was evaluated for symmetric deposits of fat on his arms and legs. At the age of 26 years, he had been hospitalized because of axonal...

ORIGINAL ARTICLE: The Mechanism of Respiratory Failure in Paraneoplastic Pemphigus

Thu, 06Â MayÂ 1999 00:00:00 -05:00

Paraneoplastic pemphigus1 is an autoimmune disease that accompanies an overt or occult neoplasm and causes blisters. It is characterized by the presence of IgG autoantibodies that react against desmosomal and...

REVIEW ARTICLE: The Pathogenesis of Melanoma Induced by Ultraviolet Radiation

Thu, 29Â AprÂ 1999 00:00:00 -05:00

Skin cancers, predominantly basal-cell and squamous-cell carcinomas, have accounted for an estimated 40 percent of all cancers in the United States in recent years, and their frequency has been increasing.12...

IMAGES IN CLINICAL MEDICINE: Severe Herpes Simplex Infection

Jessica Justman, M.D. and Marina Zabezhanskaya, M.D. — Thu, 22Â AprÂ 1999 00:00:00 -05:00

Figure 1. A 30-year-old man with the acquired immunodeficiency syndrome (CD4 cell count, 14 per cubic millimeter) presented with a six-month history of enlarging facial lesions. The lesions had not...

IMAGES IN CLINICAL MEDICINE: Congenital Hemangioma

Ernesto Bonifazi, M.D. and Francesco Mileti, M.D. — Thu, 08Â AprÂ 1999 00:00:00 -05:00

Figure 1. A newborn presented with a 9-by-12.5-cm mass in the frontal region that completely covered her right eye (Panel A). The diagnosis of hemangioma was confirmed by ultrasonography and...

ORIGINAL ARTICLE: Central Hypothyroidism Associated with Retinoid X ReceptorâSelective Ligands

Thu, 08Â AprÂ 1999 00:00:00 -05:00

Background: The occurrence of symptomatic central hypothyroidism (characterized by low serum thyrotropin and thyroxine concentrations) in a patient with cutaneous T-cell lymphoma during therapy with the retinoid X receptorâselective ligand...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Andrew McD. Johnston, M.B., Ch.B. and Aamir A. Memon, M.D. — Thu, 01Â AprÂ 1999 00:00:00 -05:00

Figure 1. A 79-year-old woman had had discoloration of her sclerae and skin for several months. What is the cause of the pigmentation?...

IMAGES IN CLINICAL MEDICINE: Keratoacanthoma

Hensin Tsao, M.D., Ph.D. and Steven R. Tahan, M.D. — Thu, 04Â MarÂ 1999 00:00:00 -05:00

Figure 1. A 71-year-old woman who had had a basal-cell carcinoma presented with a six-week history of an enlarging lesion on the upper part of her right arm (Panel A)....

IMAGES IN CLINICAL MEDICINE: Cat Scratch Disease

Michael Giladi, M.D. and Boaz Avidor, Ph.D. — Thu, 14Â JanÂ 1999 00:00:00 -05:00

Figure 1. A 17-year-old boy presented with a two-week history of a painful mass on the right side of the neck, fever, malaise, headache, and night sweats. The fever and...

IMAGES IN CLINICAL MEDICINE: Acute Febrile Neutrophilic Dermatosis in Acute Myelogenous Leukemia

Michel Starobinski, M.D. and Denis Salomon, M.D. — Thu, 03Â DecÂ 1998 00:00:00 -05:00

Figure 1. Several erythematous nodules and papulopustules developed on the arms (Panel A), upper legs, and face of a 57-year-old man, accompanied by a fever (temperature as high as 40Â°C)...

IMAGES IN CLINICAL MEDICINE: Lipodystrophy Associated with an HIV-Protease Inhibitor

Andrew Carr, M.D. and David A. Cooper, D.Sc., M.D. — Thu, 29Â OctÂ 1998 00:00:00 -05:00

Figure 1. A 53-year-old man had human immunodeficiency virus (HIV)ârelated lymphoma, which had been in remission since 1987; a CD4+ lymphocyte count of 510 cells per cubic millimeter; and an...

IMAGES IN CLINICAL MEDICINE: Verruga Peruana

Victor Jimenez-Lucho, M.D. — Thu, 13Â AugÂ 1998 00:00:00 -05:00

Figure 1. A solitary angiomatous nodule (verruga peruana) was found on the forearm of a 24-year-old resident of the Peruvian Andes. Bartonella bacilliformis, which is transmitted by sandflies, was isolated...

IMAGES IN CLINICAL MEDICINE: Loxoscelism

Edwin J. Masters, M.D. — Thu, 06Â AugÂ 1998 00:00:00 -05:00

Figure 1. A 46-year-old woman was bitten on the left arm by a brown recluse spider (Loxosceles reclusa), which was recovered and identified. Twenty-four hours later, the bite was only...

IMAGES IN CLINICAL MEDICINE: The MangoâPoison Ivy Connection

Mark O. Tucker, M.D. and Chad R. Swan, M.D. — Thu, 23Â JulÂ 1998 00:00:00 -05:00

Figure 1. A 27-year-old man had had a pruritic and eczematous rash for three days. One week earlier, he had peeled a mango, become distracted by a telephone call, and...

IMAGES IN CLINICAL MEDICINE: Ash-Leaf Spots in Tuberous Sclerosis

Gerhard Kurlemann, M.D. and Gerhard Schuierer, M.D. — Thu, 25Â JunÂ 1998 00:00:00 -05:00

Figure 1. The skin of a two-year-old boy with mental retardation appears unspotted in a photograph taken in normal daylight (left-hand panel). A photograph taken under Wood's light shows a...

IMAGES IN CLINICAL MEDICINE: Cutaneous Larva Migrans

Jane McClure Blaum, M.D. and Emily F. Omura, M.D. — Thu, 11Â JunÂ 1998 00:00:00 -05:00

Figure 1. A hookworm larva was acquired by a 47-year-old man during a vacation at a beach on the Alabama coast of the Gulf of Mexico. An isolated lesion resulted,...

IMAGES IN CLINICAL MEDICINE: Unilateral Livedo Reticularis

Charles L.G. Halasz, M.D. and Edward B. Strauss, M.D. — Thu, 16Â AprÂ 1998 00:00:00 -05:00

Figure 1. Symptoms of intermittent claudication and a painful ulceration of the right heel developed in a 50-year-old woman who smoked one pack of cigarettes per day and had diet-controlled...

ORIGINAL ARTICLE: Effect of the Timing of Treatment of Port-Wine Stains with the Flash-LampâPumped Pulsed-Dye Laser

Thu, 09Â AprÂ 1998 00:00:00 -05:00

Background: Port-wine stains can be treated with a flash-lampâpumped pulsed-dye laser, but it is uncertain whether this treatment is more effective if administered early in life, when the skin is...

IMAGES IN CLINICAL MEDICINE: Chloroma in Acute Myelogenous Leukemia

Christian Sauter, M.D. and Emanuel Jacky, M.D. — Thu, 02Â AprÂ 1998 00:00:00 -05:00

Figure 1. Panel A shows a leukemic infiltrate in the skin of a 62-year-old patient with acute myelogenous leukemia (subtype M2 according to the FrenchâAmericanâBritish system of classification). Chloromas usually...

IMAGES IN CLINICAL MEDICINE: Molluscum Contagiosum in a Patient with the Acquired Immunodeficiency Syndrome

Stephanie L. Cotell, M.D. and Natalie S. Roholt, M.D. — Thu, 26Â MarÂ 1998 00:00:00 -05:00

Figure 1. Numerous flesh-colored umbilicated papules appeared on the face of a 33-year-old man with a three-year history of the acquired immunodeficiency syndrome (AIDS) and a CD4 cell count of...

ORIGINAL ARTICLE: Mutations in Multiple Primary Melanomas

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Background: Germ-line mutations in the CDKN2A tumor-suppressor gene (also known as p16, p16 INK4a, and MTS1) have been linked to the development of melanoma in some families with inherited melanoma....

IMAGES IN CLINICAL MEDICINE: Tinea Barbae: Man and Beast

Dee Anna Glaser, M.D. and Anne T. Riordan, M.D. — Thu, 12Â MarÂ 1998 00:00:00 -05:00

Figure 1. A 23-year-old brick mason presented with a three-month history of a boggy, crusted nodule on his upper lip (Panel A). Areas of alopecia and pustules were noted within...

EDITORIAL: Predicting Outcomes of Burns

Thu, 05Â FebÂ 1998 00:00:00 -05:00

The chances of survival after burn injury have increased steadily during the past 50 years. At the end of World War II, only 50 percent of patients survived burns involving...

ORIGINAL ARTICLE: Objective Estimates of the Probability of Death from Burn Injuries

Thu, 05Â FebÂ 1998 00:00:00 -05:00

Background: Over the past 20 years, there has been remarkable improvement in the chances of survival of patients treated in burn centers. A simple, accurate system for objectively estimating the...

IMAGES IN CLINICAL MEDICINE: Bacillary Angiomatosis or Kaposi's Sarcoma?

Jordan W. Tappero, M.D., M.P.H. and Jane E. Koehler, M.D. — Thu, 25Â DecÂ 1997 00:00:00 -05:00

Figure 1. Bacillary angiomatosis and Kaposi's sarcoma can be especially difficult to differentiate clinically. In each pair of figures, one shows a bacillary angiomatosis lesion (Panels A and B) and...

ORIGINAL ARTICLE: Absence of Toxicity of Oats in Patients with Dermatitis Herpetiformis

Thu, 25Â DecÂ 1997 00:00:00 -05:00

Background: People with gluten sensitivity should avoid foods containing wheat, rye, and barley, but there has been debate about whether they should avoid oats. Although patients with celiac disease have...

IMAGES IN CLINICAL MEDICINE: Amiodarone-Induced Skin Discoloration

Chittur A. Sivaram, M.D. and Karen J. Beckman, M.D. — Thu, 18Â DecÂ 1997 00:00:00 -05:00

Figure 1. A 61-year-old man who had had a defibrillator implanted after a cardiac arrest in 1989 was treated with amiodarone in 1990 because of frequent shocks from the defibrillator....

IMAGES IN CLINICAL MEDICINE: Mucormycosis of the Hand and Forearm

Cobi Lidor, M.D., Ph.D. and James A. Nunley, M.D. — Thu, 20Â NovÂ 1997 00:00:00 -05:00

Figure 1. Mucormycosis of the hand and forearm occurred in a 28-year-old woman after a thermal burn of the right thumb caused by tap water (Panel A). The patient had...

EDITORIAL: Understanding Premature Skin Aging

Thu, 13Â NovÂ 1997 00:00:00 -05:00

Dermatologists see many patients seeking help because of skin aging. Sagging and wrinkling of the skin can be the signs of time spent on the beach in younger years or...

IMAGES IN CLINICAL MEDICINE: Cutaneous Melanoma Metastases

Martin Pecherstorfer, M.D. — Thu, 13Â NovÂ 1997 00:00:00 -05:00

Figure 1. In 1990, a 55-year-old woman presented with an acral lentiginous melanoma of the left sole. A radical extirpation of the tumor (tumor stage, T2; tumor thickness, 1.5 mm)...

ORIGINAL ARTICLE: Pathophysiology of Premature Skin Aging Induced by Ultraviolet Light

Thu, 13Â NovÂ 1997 00:00:00 -05:00

Background: Long-term exposure to ultraviolet irradiation from sunlight causes premature skin aging (photoaging), characterized in part by wrinkles, altered pigmentation, and loss of skin tone. Photoaged skin displays prominent alterations...

IMAGES IN CLINICAL MEDICINE: Orf Skin Ulcer

Philippe Roingeard, Ph.D. and Laurent Machet, M.D. — Thu, 16Â OctÂ 1997 00:00:00 -05:00

Figure 1. A painful finger ulcer (Panel A) developed in a 58-year-old man who was also found to have a palpable olecranal lymph node. The rest of his examination was...

ORIGINAL ARTICLE: A Short-Term Trial of Tacrolimus Ointment for Atopic Dermatitis

Thu, 18Â SepÂ 1997 00:00:00 -05:00

Background: Tacrolimus (FK 506) is an effective immunosuppressant drug for the prevention of rejection after organ transplantation, and preliminary studies suggest that topical application of tacrolimus is effective in the...

IMAGES IN CLINICAL MEDICINE: Infection of the Hand

Lalita Ramakrishnan, M.D., Ph.D. — Thu, 28Â AugÂ 1997 00:00:00 -05:00

Figure 1. A 35-year-old laboratory researcher who was working with Mycobacterium marinum abraded the back of her left hand, and a tender, erythematous nodule developed (Panel A). Over the next...

IMAGES IN CLINICAL MEDICINE: Infection of the Hand

Lalita Ramakrishnan, M.D., Ph.D. — Thu, 28Â AugÂ 1997 00:00:00 -05:00

Figure 1. A 35-year-old laboratory researcher who was working with Mycobacterium marinum abraded the back of her left hand, and a tender, erythematous nodule developed (Panel A). Over the next...

IMAGES IN CLINICAL MEDICINE: Positive Tzanck Smear

Lisa M. Cohen, M.D. — Thu, 21Â AugÂ 1997 00:00:00 -05:00

Figure 1. A 67-year-old man had a three-day history of pain, vesicles, and erythema of the right side of the forehead and frontal scalp, sharply demarcated at the midline. Material...

IMAGES IN CLINICAL MEDICINE: Secondary Syphilis

Fern A. Wirth, M.D. — Thu, 31Â JulÂ 1997 00:00:00 -05:00

Figure 1. A 32-year-old man presented with a five-day history of nonpruritic, copper-colored palmoplantar macules and papules (Panels A and B), several of which were crossed by creases. The patient...

IMAGES IN CLINICAL MEDICINE: Nail Changes after Chemotherapy

P.H.T.J. Slee, M.D., Ph.D. — Thu, 17Â JulÂ 1997 00:00:00 -05:00

Figure 1. A 50-year-old woman with metastatic breast cancer received seven courses of docetaxel at three-week intervals. After this treatment, the number and sizes of her lung metastases (the only...

IMAGES IN CLINICAL MEDICINE: Cutaneous Lesions in Diffuse Large-B-Cell Lymphoma

Paolo Paredi, M.D. and Oreste Pierluigi, M.D. — Thu, 01Â MayÂ 1997 00:00:00 -05:00

Figure 1. A 65-year-old man was admitted to our hospital with fatigue, weight loss, night sweats, and multiple pruritic erythematous nodules and plaques on his left shoulder, one of which...

REVIEW ARTICLE: Therapy for Acne Vulgaris

James J. Leyden, M.D. — Thu, 17Â AprÂ 1997 00:00:00 -05:00

Acne vulgaris, or acne, as it is generally called, is the most common skin disease, affecting nearly 80 percent of persons at some time between the ages of 11 and...

EDITORIAL: Should PUVA Be Abandoned?

Thu, 10Â AprÂ 1997 00:00:00 -05:00

Severe, widespread psoriasis is a devastating skin disease that can disrupt professional, social, and private life. The effectiveness of photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA)1 in...

IMAGES IN CLINICAL MEDICINE: Fish-Tank Granuloma

Steven F. Wolfe, M.D. and Arnold W. Gurevitch, M.D. — Thu, 10Â AprÂ 1997 00:00:00 -05:00

Figure 1. A 22-year-old man lacerated the back of his left index finger while cleaning his fish tank. When seen three months later, he had a verrucous, crusted plaque at...

ORIGINAL ARTICLE: Malignant Melanoma in Patients Treated for Psoriasis with Methoxsalen (Psoralen) and Ultraviolet A Radiation (PUVA)

Thu, 10Â AprÂ 1997 00:00:00 -05:00

Background: Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can...

IMAGES IN CLINICAL MEDICINE: Cutaneous Cryptococcosis

Donald J. Baker, M.D. and Annette C. Reboli, M.D. — Thu, 03Â AprÂ 1997 00:00:00 -05:00

Figure 1. A 32-year-old man infected with the human immunodeficiency virus presented with multiple papules of various sizes, many of which were umbilicated. The lesions were located mainly on his...

IMAGES IN CLINICAL MEDICINE: Bullous Pemphigoid

Jeffrey M. Levine, M.D. — Thu, 09Â JanÂ 1997 00:00:00 -05:00

Figure 1. An intact bullous lesion was found on the leg of an 84-year-old woman who had a three-day history of itching and blister formation on her thighs, arms, and...

REVIEW ARTICLE: Initial Management of Burns

William W. Monafo, M.D. — Thu, 21Â NovÂ 1996 00:00:00 -05:00

The incidence of burn injury has declined steadily over the past several decades in the United States and in some other developed countries. In-hospital fatality rates have also declined and...

REVIEW ARTICLE: Postherpetic Neuralgia â Pathogenesis, Treatment, and Prevention

Rhonda G. Kost, M.D., and Stephen E. Straus, M.D. — Thu, 04Â JulÂ 1996 00:00:00 -05:00

Spontaneous pain, pain provoked by trivial stimuli, and altered sensation accompany herpes zoster and may continue long after its characteristic rash has healed â a condition known as postherpetic neuralgia....

REVIEW ARTICLE: Streptococcal Infections of Skin and Soft Tissues

Alan L. Bisno, M.D., and Dennis L. Stevens, M.D., Ph.D. — Thu, 25Â JanÂ 1996 00:00:00 -05:00

Streptococcus pyogenes (group A in the Lancefield classification) is one of the most common human pathogens. Although this ubiquitous organism is responsible for a wide array of illnesses, most attention...

NEJM â Collection Updates for Dermatology

IMAGES IN CLINICAL MEDICINE: Cutaneous Larva Migrans

IMAGES IN CLINICAL MEDICINE: Generalized Ostraceous Psoriasis

ORIGINAL ARTICLE: Comparison of Ustekinumab and Etanercept for Moderate-to-Severe Psoriasis

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

CORRESPONDENCE: COX-2 Inhibitors in Patients with Sensitivity to Nonselective NSAIDs

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

IMAGES IN CLINICAL MEDICINE: Chromoblastomycosis

ORIGINAL ARTICLE: Combined Immunodeficiency Associated with Mutations

IMAGES IN CLINICAL MEDICINE: Geographic Tongue

EDITORIAL: Yeast Infections â Human Genetics on the Rise

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2009 â A 20-Year-Old Man with Sore Throat, Fever, and Rash

ORIGINAL ARTICLE: Human Dectin-1 Deficiency and Mucocutaneous Fungal Infections

ORIGINAL ARTICLE: A Homozygous Mutation in a Family with Susceptibility to Fungal Infections

IMAGES IN CLINICAL MEDICINE: Pachyderma

CORRESPONDENCE: Aprepitant as an Antipruritic Agent?

IMAGES IN CLINICAL MEDICINE: Diagnostic Finding in the Iris

IMAGES IN CLINICAL MEDICINE: Acquired Melanonychia

ORIGINAL ARTICLE: Inhibition of the Hedgehog Pathway in Advanced Basal-Cell Carcinoma

IMAGES IN CLINICAL MEDICINE: Giant Congenital Nevus

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

REVIEW ARTICLE: Psoriasis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2009 â A 59-Year-Old Man with Skin and Pulmonary Lesions after Chemotherapy for Leukemia

IMAGES IN CLINICAL MEDICINE: Traumatic Bleb

IMAGES IN CLINICAL MEDICINE: Cutaneous Anthrax

IMAGES IN CLINICAL MEDICINE: Tattoo Allergy

IMAGES IN CLINICAL MEDICINE: Lipomatosis of the Tongue

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2009 â A 79-Year-Old Woman with a Blistering Cutaneous Eruption

ORIGINAL ARTICLE: An Autoinflammatory Disease Due to Homozygous Deletion of the Locus

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

IMAGES IN CLINICAL MEDICINE: Tongue Necrosis in a Patient with Essential Thrombocytosis

BOOK REVIEW:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

CORRESPONDENCE: Nickel Allergy in Danish Women before and after Nickel Regulation

IMAGES IN CLINICAL MEDICINE: White Tongue

IMAGES IN CLINICAL MEDICINE: Extravasation of Epirubicin

CLINICAL PRACTICE: Fungal Nail Disease

REVIEW ARTICLE: Scleroderma

IMAGES IN CLINICAL MEDICINE: Familial Hypercholesterolemia

CORRESPONDENCE: Revertant Mosaicism â Patchwork in the Skin

IMAGES IN CLINICAL MEDICINE: Gingival and Periungual Vasculopathy of Juvenile Dermatomyositis

IMAGES IN CLINICAL MEDICINE: Lupoid Leishmaniasis

IMAGES IN CLINICAL MEDICINE: Penile Papules

IMAGES IN CLINICAL MEDICINE: Green Nails

BOOK REVIEW:

IMAGES IN CLINICAL MEDICINE: Lymphedema Tarda

CLINICAL THERAPEUTICS: Excision and Skin Grafting of Thermal Burns

IMAGES IN CLINICAL MEDICINE: Pediculosis of the Pubis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

BOOK REVIEW:

IMAGES IN CLINICAL MEDICINE: Metallic Mercury Embolism to the Hand

CLINICAL PRACTICE: Seborrheic Dermatitis

CORRESPONDENCE: An Î±-MelanocyteâStimulating Hormone Analogue in Erythropoietic Protoporphyria

IMAGES IN CLINICAL MEDICINE: Spider Angiomas

IMAGES IN CLINICAL MEDICINE: Medication-Induced Gingival Hypertrophy

CLINICAL PRACTICE: Vitiligo

IMAGES IN CLINICAL MEDICINE: Subungual Exostosis

CORRESPONDENCE: Small-Cell Lung Cancer and Necrolytic Migratory Erythema

IMAGES IN CLINICAL MEDICINE: Periungual Tungiasis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

IMAGES IN CLINICAL MEDICINE: Keratoacanthoma

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

CORRESPONDENCE: A Case of Conjugal Azathioprine-Induced Contact Hypersensitivity

IMAGES IN CLINICAL MEDICINE: Periungual Fibromas

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection

IMAGES IN CLINICAL MEDICINE: Bedbug Bites

IMAGES IN CLINICAL MEDICINE: Squamous-Cell Carcinoma Manifesting as a Cutaneous Horn

CORRESPONDENCE: Scrotal Cutaneous Side Effects of Sunitinib

IMAGES IN CLINICAL MEDICINE: The StewartâTreves Syndrome

IMAGES IN CLINICAL MEDICINE: Allergic Contact Dermatitis from a Henna Tattoo

IMAGES IN CLINICAL MEDICINE: Vitiligo and Cutaneous Melanoma

IMAGES IN CLINICAL MEDICINE: Digital Verrucae

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

IMAGES IN CLINICAL MEDICINE: Systemic Sclerosis and Acral Osteolysis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2008 â A 63-Year-Old HIV-Positive Man with Cutaneous Merkel-Cell Carcinoma

ORIGINAL ARTICLE: Treatment of Metastatic Melanoma with Autologous CD4+ T Cells against NY-ESO-1

CLINICAL PROBLEM-SOLVING: A Joint Venture

NEJM â Collection Updates for Dermatology

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 41-2009 â A 16-Year-Old Boy with Hypothermia and Frostbite

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

EDITORIAL: Yeast Infections â Human Genetics on the Rise

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2009 â A 20-Year-Old Man with Sore Throat, Fever, and Rash

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2009 â A 56-Year-Old Woman with Fever, Rash, and Lymphadenopathy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2009 â A 59-Year-Old Man with Skin and Pulmonary Lesions after Chemotherapy for Leukemia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2009 â A 79-Year-Old Woman with a Blistering Cutaneous Eruption

ORIGINAL ARTICLE: An Autoinflammatory Disease with Deficiency of the Interleukin-1âReceptor Antagonist

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2009 â A 30-Year-Old Man with Progressive Neurologic Deficits

CORRESPONDENCE: Revertant Mosaicism â Patchwork in the Skin

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2009 â A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

CORRESPONDENCE: An Î±-MelanocyteâStimulating Hormone Analogue in Erythropoietic Protoporphyria

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2008 â A 10-Year-Old Girl with Recurrent Oral Lesions and Cutaneous Bullae

CLINICAL DECISIONS: Management of Skin and Soft-Tissue Infection â Polling Results

IMAGES IN CLINICAL MEDICINE: The StewartâTreves Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2008 â A 63-Year-Old HIV-Positive Man with Cutaneous Merkel-Cell Carcinoma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

CLINICAL PROBLEM-SOLVING: What's the Connection? â A 26-year-old white man presented to our referral hospital with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2008 â An 80-Year-Old Woman with Cutaneous Basal-Cell Carcinomas and Cysts of the Jaws

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2007 â A 5-Month-Old Girl with Skin Lesions

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2007 â A 44-Year-Old Woman with Generalized, Painful, Ulcerated Skin Lesions

CLINICAL PROBLEM-SOLVING: The Leading Diagnosis â A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2007 â A 31-Year-Old Woman with Rash, Fever, and Hypotension

CLINICAL PROBLEM-SOLVING: No Respecter of Age â A previously healthy 65-year-old woman went to her primary care physician in late August, seeking evaluation of a âspotâ that had appeared on her right leg 3 weeks earlier

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2007 â A Newborn Girl with Skin Lesions

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

IMAGES IN CLINICAL MEDICINE: PeutzâJeghers Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

EDITORIAL: Rituximab and Pemphigus â A Therapeutic Advance

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2007 â A 9-Year-Old Boy with Bone Pain, Rash, and Gingival Hypertrophy

CLINICAL PROBLEM-SOLVING: A Hand-Carried Diagnosis â A 34-year-old black woman presented to a walk-in clinic with a 3-day history of malaise

IMAGES IN CLINICAL MEDICINE: The Sign of LeserâTrÃ©lat

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2007 â A 59-Year-Old Man with Fever and Pain and Swelling of Both Eyes and the Right Ear

CLINICAL PROBLEM-SOLVING: Building a Diagnosis from the Ground Up â A 49-year-old man came to the clinic with a 1-week history of suprapubic pain and fever

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Skin Discolorations in a Bank Employee

CLINICAL THERAPEUTICS: VaricellaâZoster Vaccine for the Prevention of Herpes Zoster

ORIGINAL ARTICLE: Redarkening of Port-Wine Stains 10 Years after Pulsed-DyeâLaser Treatment

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2007 â A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2007 â A 49-Year-Old Woman with a Pigmented Lesion on the Arm

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2006 â A 5-Year-Old Boy with Headache and Abdominal Pain