Annular purpuric rash on the lower extremities by ProQuest


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									dc1208.qxp   11/25/2008    1:58 PM    Page 52

                               Dermatology Clinic
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        CASE #1

      Rapidly enlarging
      conical lesion on
      the plantar surface
      A 30-year-old man had a markedly hyperkeratotic conical le-
      sion on his sole between the first and second metatarsals. He
      noted that the lesion, which measured 1.5 × 1.1 cm at the
      base, was painful only when he walked or stood (his ambu-
      lation had been limited for the past nine months following a
      motor vehicle accident).Topical wart remedies had provided
      no relief.The patient believed the growth had first appeared as
      a wart about one year ago,but it had grown tremendously over
      the past six months.He was worried that it was cancerous.

      What is your diagnosis? Turn to page 56

                                                                          CASE #2

                                                                        Annular purpuric
                                                                        rash on the
                                                                        lower extremities
                                                                        BY RICHARD A. KRATHEN, MD, AND SYLVIA HSU, MD
                                                                        A 47-year-old man had a three-month history of intermittent
                                                                        rash on the lower legs.The rash consisted of symmetric ringlike
                                                                        coalescing purpuric patches in a netlike pattern.There were no
                                                                        ulcerations, vesicles, or bullae.The asymptomatic rash was not
                                                                        palpable or associated with fevers,arthralgia or arthritis,oral ul-
                                                                        cers, or hair loss. Other health issues were mild hypertension
                                                                        controlled on enalapril and hepatitis C likely acquired with the
                                                                        three amateur tattoos he got while in prison 20 years ago.

                                                                        What is your diagnosis? Turn to page 56

dc1208.qxp   11/25/2008       1:58 PM      Page 56

                                                   Dermatology Clinic

         CASE #1            Cutaneous horn                                        CASE #2           Livedo reticularis
                                         The lesion was a cutaneous                                             The rash of livedo reticularis
                                         horn, or cornu cutaneum, a                             
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