A 41-year-old man comes to the physician with a faint skin rash over his upper body.  He first noticed it in the spring season, but it worsened during the summer.  The patient has mild itching, but otherwise the rash is asymptomatic.  He takes omeprazole for acid reflux but his medical history is otherwise unremarkable.  He does not use tobacco, alcohol, or illicit drugs.  The patient has been sexually active with 2 partners during the last year, and uses condoms on most occasions.  The physical examination findings are shown below.

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Which of the following is the most likely diagnosis in this patient?

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Which of the following is the best treatment for this patient?

A 48-year-old woman comes to the office due to a recurrent rash.  Six months ago, a rash developed on her legs that she describes as “red patches with raised areas.”  The rash worsened that night with intense itching that disrupted her sleep.  It spontaneously resolved over the next day.  Since then, she has had repeated episodes of similar symptoms on her arms, legs, and back, each lasting 8-12 hours and occurring nearly every 2-3 weeks.  She reports no trauma, insect bites, travel history, sick contacts, or changes in weight.  Medical history is notable for hypertension treated with lisinopril.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.1 C (97 F), blood pressure is 138/77 mm Hg, and pulse is 78/min.  Physical examination is within normal limits.  The patient brings a photo of the rash, shown in the image below, from her most recent episode 2 days ago. Complete blood count, urinalysis, erythrocyte sedimentation rate, and liver function studies are within normal limits.

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Which of the following is the best next step in management of this patient’s condition?

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The patient currently has no rash but would like treatment recommendations for possible future episodes.  Which of the following is the most appropriate treatment for this patient?

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The patient is concerned about her long-term prognosis.  Which of the following is the most appropriate advice for this patient?

A 70-year-old man comes to the office due to a skin rash.  He has widespread redness and blistering across his neck and trunk, which are associated with severe itching.  The rash was preceded by 4 weeks of widespread pruritus and occasional urticaria.  The patient has a history of hypertension controlled with amlodipine for 2 years and lisinopril for the last 6 months.  Vital signs are within normal limits.  On examination, he has scattered vesicles and bullae with underlying erythema and urticaria, as shown in the image below:

Which of the following is the most appropriate next step in management of this patient’s condition?

A 23-year-old woman comes to the physician with skin lesions.  She noticed a small papule 2 weeks ago and now has additional similar lesions.  There is no associated pain.  The patient has had no systemic symptoms except 1 day of diarrhea that resolved 3 weeks ago.  She has no previous medical problems and works as an assistant at a veterinary facility.  The patient has been sexually active with a new partner.  She drinks alcohol socially, but does not use tobacco or illicit drugs.  Her vital signs are normal.  Physical examination is normal except for the lesions as shown below.

Which of the following is the most likely cause of her skin lesions?

A 26-year-old man comes to the office due to upper and lower limb skin lesions that have been present for the past week.  The lesions started as small, red papules that gradually enlarged but are not painful or pruritic.  The patient had similar lesions several months ago that spontaneously resolved in about 2 weeks.  Prior to the current episode, he was not taking any medications.  The patient occasionally drinks alcohol and does not use tobacco or recreational drugs.  Vital signs are normal.  Skin examination shows several lesions (shown below) scattered over the extremities with relative sparing of the trunk.

Tender erosions are also present on the oral mucosa.  Which of the following is most closely associated with this patient’s skin condition?

A 36-year-old woman comes to the physician for a rash on her lower abdomen.  The rash first appeared 3 months ago and has been slowly expanding in the same area.  It is mildly pruritic but otherwise asymptomatic.  Treatment with topical emollients has not been beneficial.  The patient has a history of depression for which she takes citalopram but is otherwise healthy.  Skin examination findings are shown in the image below.

Which of the following is the most likely explanation for this patient’s symptoms?

A 43-year-old woman comes to the physician for a rash on her hands.  The rash began 8–10 weeks ago.  She moved to the community approximately 4 months ago and works as a nurse in the dialysis unit at a nearby hospital.  The patient’s past medical history is significant for hypertension treated with hydrochlorothiazide.  She also takes naproxen regularly for headaches.  Her hands are shown in the image below:

Which of the following is the most likely diagnosis?

A 29-year-old man comes to the physician with nodules under his arm.  He reports a 6-month history of slowly enlarging nodules in his right axilla associated with mild discomfort.  He has a history of chronic obesity but is otherwise healthy.  The patient has a 10-pack-year smoking history and does not drink alcohol.  Skin examination shows swollen, nodular lesions in his right axilla with moderate scarring and mild tenderness to palpation.  He has no other significant skin lesions.

Which of the following is the best next step in management of this patient?

A 43-year old man comes to the physician with a 2-day history of blistering and severe itching on his hand.  He developed a superficial burn on his index finger from hot candle wax 1 week ago and has been treating the burn with a topical ointment containing neomycin, polymyxin B, and bacitracin.  His past medical history is significant for irritable bowel syndrome with chronic diarrhea.  The patient is not taking any prescription medications and has no known drug allergies.  On examination, he has faint erythema of the skin between the index and middle fingers, several vesicles and small bullae are present as shown in the image below:

Which of the following is the most appropriate next step in management of this patient’s skin disorder?

A 28-year-old man comes to the office due to a rash on the lower extremity.  The patient noticed a pruritic papule on the dorsum of his right foot just prior to returning from a south Florida beach 2 days ago.  He walked barefoot on the beach but does not recall any trauma.  Since his return home, the rash and itching have progressively worsened.  The patient has no other medical problems and takes no medications.  Physical examination findings are shown below.

Which of the following is the most likely cause of this patient’s current condition?

A 64-year-old woman comes to the office due to thickening and discoloration of her toenails.  The patient’s nails are rough, which is starting to cause her pain and making it difficult for her to wear shoes with socks.  She first noticed both big toes were affected a few months ago; subsequently, several other toenails became affected as well.  On physical examination, the affected nails appear rough, brittle, and discolored, as shown in the image below.  Potassium hydroxide preparation of nail scrapings shows dermatophytic hyphae and arthrospores.

Which of the following is the most effective treatment regimen for this patient’s condition?

A 64-year-old man comes to the office due to blisters on his trunk and groin.  Itching has occurred for the past several weeks, and blisters developed a week ago.  He has a history of hypertension and osteoarthritis.  The patient received the zoster vaccine at age 60.  Examination shows numerous 0.5- to 3-cm fluid-filled blisters.  A skin biopsy is performed, and microscopic findings are shown in the image below:

Which of the following is the most likely diagnosis?

A 52-year-old woman comes to the office due to a 2-month history of oral lesions that cause pain with chewing and swallowing food.  The patient did not seek treatment because she thought the lesions would go away on their own, but they have persisted.  On examination, there are erosions of the buccal and gingival mucosa, as shown in the image below.  There are several flaccid bullae with erosions scattered over her trunk.  The blisters spread laterally with pressure, and traction on seemingly uninvolved skin produces blistering.  Autoantibodies directed against which of the following structures are most likely responsible for this process?

A 45-year-old woman comes to the office for evaluation of a rash.  The rash started 3 weeks ago under her breasts and has gradually spread to her chest.  There is no associated pruritus.  The patient has a history of diabetes, hypertension, and gastroesophageal reflux disease.  Her medications include hydrochlorothiazide, metformin, and omeprazole.  She has no history of tobacco or alcohol use.  The patient’s vital signs are within normal limits.  Her BMI is 38 kg/m².  Skin examination is shown in the image below.  There is no warmth or tenderness around the lesions.

Which of the following is the most likely organism causing this patient’s rash?

A 45-year-old woman comes to the physician for evaluation of lesions on her chest and axillae.  She initially noticed a small papule at her right axilla 6 months ago, followed by additional lesions in the same area extending toward her right breast.  There is no associated pain, erythema, discharge, or pruritus.  The patient is concerned about the number of lesions and requests further evaluation.  She has a history of asthma treated with an albuterol inhaler as needed.  She does not use tobacco or alcohol.  Her vital signs are within normal limits.  Skin examination of the right axillary region is shown below.  The remainder of her physical examination is normal.

Which of the following is associated with this patient’s skin condition?

A 29-year-old man comes to the physician for a routine preventive examination.  He is currently feeling well but states that he has always had “some dark spots” on his back.  The patient has no family history of heart disease or cancer.  He does not spend much time outdoors and had no prior sunburn.  He does not smoke.  Physical examination shows many pigmented lesions on his back as shown below.

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Which of the following is the best factor to assess risk of malignancy in a suspicious skin lesion in this patient?

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The following 8-mm lesion is seen on close skin inspection.

Which of the following is the best next step in the management of this patient’s skin lesion?