Department of Family & Community Medicine

Dermatology Quiz

Quiz 195 Answer:


For review... Case 195

Our next patient is a 29 year old woman who presents with this lesion on her chin. She has had many similar lesions in the past and reports she had one on her temple that was treated by another provider about 1 month prior to this visit. What is your diagnosis of her current presentation, and what treatment do you think she received on her temple lesion?

195 chin close195 temple close195 temple close 2

Congratulations to all who diagnosed our young woman's cystic acne. If you look carefully at her chin photo you can see a couple of lesser lesions. It is common to see women in their twenties and thirties come in complaining that they are not teenagers any more but they still get these frustrating cystic acne lesions that often never come to a head and just smolder for a week or more. Sometimes they manipulate them and sometimes they end up scarring. Oral antibiotics are a useful treatment if they have frequent or numerous lesions. If they just get an occasional lesion, one of my favorite treatments is to inject them CAREFULLY with steroids. I dilute triamcinolone down to 1 mg /ml although some use a bit higher concentration. If it is used in too high of a concentration like 20 or 40 mg/ml straight from the bottle you can get the steroid atrophy that she has on her temple courtesy of the other provider. Fortunately over several months the atrophy has lessened for her which is often the case although not guaranteed. My technique is to dilute as above then using a very fine needle inject into the dermis into the palpable middle of the lesion - just a tiny amount. If you see the lesion blanch or can see the plunger move in the syringe then that is usually enough. I prefer to inject non-manipulated lesions that are in the erythematous nodule stage.

Quiz 196 Question:

Our next patient is a 39 year old woman who presented with these findings on her hands. She reports that two days earlier she was in one of our local riparian areas and believes she was bitten by insects. She reports that the lesions started out as small dots then became increasingly swollen, blistered and painful with some associated itching. The findings on her fingers are somewhat atypical for insect bites, but for this quiz, please focus on the dorsum of her hand. What is your diagnosis regarding the process on her hand and what treatment you recommended if treatment is indicated?

196 perspective196 dorsum

Daniel L. Stulberg, MD

Professor Department of Family and Community Medicine

University of New Mexico

All original material Copyright by Daniel L. Stulberg, MD

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