Clinical Comestibles?

1. This 45-year-old woman’s skin has multiple small, soft, compressible papules, one of which is apt to bleed when scratched. She is concerned that these “cherry red” lesions are precancerous.

Diagnosis: Cherry angiomas, also known as de Morgan spots, are extremely common lesions; though usually asymptomatic, they may bleed with trauma. They occur most commonly as multiple asymptomatic lesions on the trunk and arms. These capillary hemangiomas are dome-shaped, small (0.1 to 0.5 cm in diameter), and bright red to violaceous; they can be flat, raised, or nodular.

Cherry angiomas form as a result of the development of multiple capillaries with narrow lumens and prominent endothelial cells arranged in a lobular pattern in the papillary dermis. Effective treatment options include curettage, laser ablation, and electrodesiccation.

For more information, see Kim, J-H, Park H-Y, Ahn SK. Cherry Angiomas on the Scalp. Case Rep Dermatol. 2009;1(1):82–86.

2. A 60-year-old African-American woman presents with painful swelling of two years’ duration. She delayed care due to lack of insurance. The patient is hypertensive, and her left breast and nipple are retracted, with darkened skin and a peau d’orange texture.

Diagnosis: Palpation of the firm, matted nodes in the left axilla elucidated the diagnosis of breast cancer with lymphedema. Lymphedema causes the skin of the breast to resemble that of an orange.

The patient was referred to the local university’s breast center. Although the prognosis was poor, it was important to make every effort to have the disease staged to determine the most appropriate therapy.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Breast cancer. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:551-556.

For more information, see “Swollen breast and arm.” The Journal of Family Practice.  February 6, 2015.

3. This patient presents with her cheeks quite red and covered with hyperkeratotic, rough, pinpoint papules. No other blemishes or lesions are seen on her face, but there are hundreds of hyperkeratotic papules on her bilateral triceps, giving a “chicken skin” appearance.

Diagnosis: Keratosis pilaris (KP) is an extremely common and harmless problem that affects up to 70% of newborns, though it may not fully express until age 1 or 2. Caused by an overproduction of perifollicular keratin, KP is inherited in an autosomal dominant pattern and is often seen in conjunction with atopic dermatitis and related conditions (eg, eczema, xerosis, asthma, icthyosis). KP can manifest anywhere on the body except glabrous skin (palms and soles).

Variants of KP are also common; the one affecting this patient is keratosis pilaris rubra facei. This condition is often confused with acne, but treating it as such worsens irritation—especially in the wintertime, when humidity levels are low.

For more information, see “Acne: Maybe She's Born With It?” Clinician Reviews. 2016 July;26(7):W1.

4. A 5-year-old girl has a fever of 102.4°F and “strawberry tongue.” The posterior pharynx is erythematous with slight exudate visible. The anterior cervical lymph nodes are mildly tender and somewhat enlarged. No rashes are noted.

Diagnosis: The child’s strawberry tongue and scarlet fever were caused by strep pharyngitis. Strawberry tongue, identified by prominent papillae along with erythema (resembling a strawberry), is most commonly seen in children with scarlet fever or Kawasaki disease and usually develops within the first two to three days of illness. A white or yellowish coating typically precedes the distinctive red tongue with white papillae.

In this case, oral penicillin VK was prescribed, along with ibuprofen for the fever and sore throat. Improvement was noted within 24 hours, but the full 10-day course of pencillin was completed to prevent rheumatic fever.

For more information, see “Papillae on tongue.” Journal of Family Practice. January 24, 2014.

1. This 45-year-old woman’s skin has multiple small, soft, compressible papules, one of which is apt to bleed when scratched. She is concerned that these “cherry red” lesions are precancerous.

Diagnosis: Cherry angiomas, also known as de Morgan spots, are extremely common lesions; though usually asymptomatic, they may bleed with trauma. They occur most commonly as multiple asymptomatic lesions on the trunk and arms. These capillary hemangiomas are dome-shaped, small (0.1 to 0.5 cm in diameter), and bright red to violaceous; they can be flat, raised, or nodular.

Cherry angiomas form as a result of the development of multiple capillaries with narrow lumens and prominent endothelial cells arranged in a lobular pattern in the papillary dermis. Effective treatment options include curettage, laser ablation, and electrodesiccation.

For more information, see Kim, J-H, Park H-Y, Ahn SK. Cherry Angiomas on the Scalp. Case Rep Dermatol. 2009;1(1):82–86.

2. A 60-year-old African-American woman presents with painful swelling of two years’ duration. She delayed care due to lack of insurance. The patient is hypertensive, and her left breast and nipple are retracted, with darkened skin and a peau d’orange texture.

Diagnosis: Palpation of the firm, matted nodes in the left axilla elucidated the diagnosis of breast cancer with lymphedema. Lymphedema causes the skin of the breast to resemble that of an orange.

The patient was referred to the local university’s breast center. Although the prognosis was poor, it was important to make every effort to have the disease staged to determine the most appropriate therapy.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Breast cancer. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:551-556.

For more information, see “Swollen breast and arm.” The Journal of Family Practice.  February 6, 2015.

3. This patient presents with her cheeks quite red and covered with hyperkeratotic, rough, pinpoint papules. No other blemishes or lesions are seen on her face, but there are hundreds of hyperkeratotic papules on her bilateral triceps, giving a “chicken skin” appearance.

Diagnosis: Keratosis pilaris (KP) is an extremely common and harmless problem that affects up to 70% of newborns, though it may not fully express until age 1 or 2. Caused by an overproduction of perifollicular keratin, KP is inherited in an autosomal dominant pattern and is often seen in conjunction with atopic dermatitis and related conditions (eg, eczema, xerosis, asthma, icthyosis). KP can manifest anywhere on the body except glabrous skin (palms and soles).

Variants of KP are also common; the one affecting this patient is keratosis pilaris rubra facei. This condition is often confused with acne, but treating it as such worsens irritation—especially in the wintertime, when humidity levels are low.

For more information, see “Acne: Maybe She's Born With It?” Clinician Reviews. 2016 July;26(7):W1.

4. A 5-year-old girl has a fever of 102.4°F and “strawberry tongue.” The posterior pharynx is erythematous with slight exudate visible. The anterior cervical lymph nodes are mildly tender and somewhat enlarged. No rashes are noted.

Diagnosis: The child’s strawberry tongue and scarlet fever were caused by strep pharyngitis. Strawberry tongue, identified by prominent papillae along with erythema (resembling a strawberry), is most commonly seen in children with scarlet fever or Kawasaki disease and usually develops within the first two to three days of illness. A white or yellowish coating typically precedes the distinctive red tongue with white papillae.

In this case, oral penicillin VK was prescribed, along with ibuprofen for the fever and sore throat. Improvement was noted within 24 hours, but the full 10-day course of pencillin was completed to prevent rheumatic fever.

For more information, see “Papillae on tongue.” Journal of Family Practice. January 24, 2014.

1. This 45-year-old woman’s skin has multiple small, soft, compressible papules, one of which is apt to bleed when scratched. She is concerned that these “cherry red” lesions are precancerous.

Diagnosis: Cherry angiomas, also known as de Morgan spots, are extremely common lesions; though usually asymptomatic, they may bleed with trauma. They occur most commonly as multiple asymptomatic lesions on the trunk and arms. These capillary hemangiomas are dome-shaped, small (0.1 to 0.5 cm in diameter), and bright red to violaceous; they can be flat, raised, or nodular.

Cherry angiomas form as a result of the development of multiple capillaries with narrow lumens and prominent endothelial cells arranged in a lobular pattern in the papillary dermis. Effective treatment options include curettage, laser ablation, and electrodesiccation.

For more information, see Kim, J-H, Park H-Y, Ahn SK. Cherry Angiomas on the Scalp. Case Rep Dermatol. 2009;1(1):82–86.

2. A 60-year-old African-American woman presents with painful swelling of two years’ duration. She delayed care due to lack of insurance. The patient is hypertensive, and her left breast and nipple are retracted, with darkened skin and a peau d’orange texture.

Diagnosis: Palpation of the firm, matted nodes in the left axilla elucidated the diagnosis of breast cancer with lymphedema. Lymphedema causes the skin of the breast to resemble that of an orange.

The patient was referred to the local university’s breast center. Although the prognosis was poor, it was important to make every effort to have the disease staged to determine the most appropriate therapy.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Breast cancer. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:551-556.

For more information, see “Swollen breast and arm.” The Journal of Family Practice.  February 6, 2015.

3. This patient presents with her cheeks quite red and covered with hyperkeratotic, rough, pinpoint papules. No other blemishes or lesions are seen on her face, but there are hundreds of hyperkeratotic papules on her bilateral triceps, giving a “chicken skin” appearance.

Diagnosis: Keratosis pilaris (KP) is an extremely common and harmless problem that affects up to 70% of newborns, though it may not fully express until age 1 or 2. Caused by an overproduction of perifollicular keratin, KP is inherited in an autosomal dominant pattern and is often seen in conjunction with atopic dermatitis and related conditions (eg, eczema, xerosis, asthma, icthyosis). KP can manifest anywhere on the body except glabrous skin (palms and soles).

Variants of KP are also common; the one affecting this patient is keratosis pilaris rubra facei. This condition is often confused with acne, but treating it as such worsens irritation—especially in the wintertime, when humidity levels are low.

For more information, see “Acne: Maybe She's Born With It?” Clinician Reviews. 2016 July;26(7):W1.

4. A 5-year-old girl has a fever of 102.4°F and “strawberry tongue.” The posterior pharynx is erythematous with slight exudate visible. The anterior cervical lymph nodes are mildly tender and somewhat enlarged. No rashes are noted.

Diagnosis: The child’s strawberry tongue and scarlet fever were caused by strep pharyngitis. Strawberry tongue, identified by prominent papillae along with erythema (resembling a strawberry), is most commonly seen in children with scarlet fever or Kawasaki disease and usually develops within the first two to three days of illness. A white or yellowish coating typically precedes the distinctive red tongue with white papillae.

In this case, oral penicillin VK was prescribed, along with ibuprofen for the fever and sore throat. Improvement was noted within 24 hours, but the full 10-day course of pencillin was completed to prevent rheumatic fever.

For more information, see “Papillae on tongue.” Journal of Family Practice. January 24, 2014.