CME Dermatologic Look-Alikes
■ LEARNING OBJECTIVE: To improve the clinician’s ability to distinguish and properly
CE treat dermatologic conditions with similar presentations.
■ COMPLETE THE POSTTEST: Page 57 ■ ADDITIONAL CME/CE: Pages 21, 39
Cutaneous lesions
BY DAMOLA A. ADEGBENRO, MD, AND NOAH S. SCHEINFELD, MD, JD
CASE #1 CASE #2
A 46-year-old man presented with longstanding ulcer- A man in his mid-40s with no history of skin cancer
ative lesions on his lower leg. Rather than oral medi- presented with a painless forearm lesion that did not itch
cation, he preferred pimecrolimus 0.1% ointment and or burn. This erythematous keratotic papulo-nodule
clobetasol gel 0.05% applied twice a day. This decreased was growing rapidly and had appeared approximately
his pain but did not lead to resolution of the lesions. He one month earlier. The patient suspected a spider bite
also received benefit from a 3-cc injection of intralesional or infection. When he was younger, the patient had
kenalog with a concentration of 2.5 mg/cc. The patient been subjected to a great deal of sun exposure. A biopsy
did not have any associated bowel symptoms, and a showed well-differentiated squamous epithelium with
colonoscopy was normal. He did not have arthritis of any pleomorphism and large cells at the core with surround-
type, although the lesions made ambulation difficult. ing hyperplasia in a craterlike pattern.
www.clinicaladvisor.com • THE CLINICAL ADVISOR • AUGUST 2010 53
CME
CE Dermatologic Look-Alikes
CASE #1 Pyoderma gangrenosum The initial presentation of PG is that of a painful superfi-
cial hemorrhagic pustule or deep-seated nodule. This later
Pyoderma gangrenosum (PG) develops into an ulcer with irregular, raised, and dusky-red
is a rare, ulcerative, cutaneous or violaceous borders with a boggy, purulent, and necrotic
condition that affects approxi- base. As the ulcer advances, the raised border becomes
mately three to 10 individuals soggy and perforated such that the area drains pus when
per million population each pressure is applied. The lesion is typically surrounded by
year.1 Although the condi- an erythematous halo that spreads centrifugally from the
tion may affect individuals at advancing border of the ulcer into nearby skin. The base
any age, it most often occurs of the ulcer may be covered by hemorrhagic exudates or
between the second and fifth necrotic eschar or become studded with microabscesses.
decades of life. PG develops There is often a solitary lesion, but sometimes multiple
in