Images in Clinical Medicine

By Dr. Ebtisam Elghblawi
Corresponding Author Dr. Ebtisam Elghblawi
Dermatology, - Libyan Arab Jamahiriya
Submitting Author Dr. Ebtisam Elghblawi

PC, Nevus, Ganglion, Psoriasis.

Elghblawi E. Images in Clinical Medicine, Dermatology.. WebmedCentral DERMATOLOGY 2012;3(2):WMC003060
doi: 10.9754/journal.wmc.2012.003060

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 20 Feb 2012 11:02:48 AM GMT
Published on: 21 Feb 2012 05:15:07 PM GMT


Figure 1: Thick palms with thick elongated curved nails (rare case)
A 10-year old female patient was referred to the dermatology clinic. Clinical examination revealed hyperkeratotic curved nails of both fingers and toes, together with patchy thickening of palms and soles. The patient also showed some painful bullous lesions on the soles which making walking difficult. Family history was negative.
1. What is your diagnosis?
2. What is believed to be the aetiology of this lesion?
3. How would you treat this lesion?
1. pachyonychia congenita (PC)
2. PC is a very rare genetic disorder of keratinisation that affects the nails, skin (especially palms and soles), oral mucosa and laryngeal mucosa, teeth, and hair.
3. Treatment given was emollients such as urea cream 10%, and keratolytics; salicylic acid
ointment 20% with occlusive dressings to soften the thickened nail plate, and Oral retinoids;
decutan cap 20 mg which contains the active substance isotretinoin, which belongs to the
group of drugs called retinoids, which are structurally related to vitamin A. She showed
dramatic improvement to some extent on this treatment.
Successful targeted therapies are still currently lacking and only directing at the explicit manifestation per se, therefore a good genetic counselling is advised in order to avoid such conditions which would mean a pain to the family, and community.

Figure 2: A congenital facial skin lesion
A young man, 33 years old, born with a reddish facial lesion on the left side, which slightly decreased with age as he noticed.
1. What is your diagnosis?
2. What is believed to be the aetiology of this lesion?
3. How would you treat this lesion?
1. a birth mark; nevus flammeus. A large congenital vascular nevus having a purplish colour; it is usually found on the head and neck and persists throughout life
2. Capillary hemangioma (Capillary malformation)
3. Treatment is often not satisfactory. Camouflage cosmetics are used to cover the lesion and are the treatment of choice. Also may be removed using laser surgery. Some trials of oral steroids can be given as well.

Figure 3: An atrophic erythematous, well-defined, patches over the butter fly facial area and both forearms.
A 36 years old man, presented with a reddish facial lesion over the butter fly area and both extensors of the upper limbs.
1. What is your diagnosis?
2. What is believed to be the aetiology of this lesion?
3. How would you treat this lesion?
1. Discoid Lupus Erythematosus (DLE). An uncommon rash usually made worse by exposure to sunlight.
2. Autoimmune aetiology
3. Treatment Sun protection (clothing and sunscreens), strong topical steroids carefully applied to the lesions, intralesional diluted steroids into resistant areas, antimalarials such as hydroxychloroquine, and ensure eyes examination.

Figure 4: A solitary solid lump on dorsa hand.
A lady in her mid 30s came with a small swelling on her left hand dorsa.
1. What is your diagnosis?
2. What is believed to be the aetiology of this lesion?
3. How would you treat this lesion?
1. Ganglion cyst which filled with clear fluid or gel.
2. Actual cause is unknown although they may form in the presence of joint or tendon irritation or mechanical changes
3. It may resolve by itself, if not, an aspiration can be performed to remove the fluid from the cyst and decompress it. Recurrence of the cyst is common.

Figure 5: Thick silvery scales over a knee
A young man in his 40s came with a history of thick silvery scales all over his knees. He gave a history of remission and exacerbation. No FH.
1. What is your diagnosis?
2. What is believed to be the aetiology of this lesion?
3. How would you treat this lesion?
1. Psoriasis
2. Cause remains unknown. It is speculated a combination of factors, like genetic predisposition and environmental factors. Also psoriasis is common to be found in members of the same family.
3. The best treatment is individually tailored by the treating physician and depends, on the type of disease, its severity, and the total body area involved.

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Competing Interests



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3 reviews posted so far

Images in Clinical Medicine, Dermatology
Posted by Dr. Pramod Kumar on 29 Aug 2015 04:48:11 PM GMT Reviewed by Interested Peers
This review will not be counted towards final review score for this article and for its inclusion into WebmedCentral Peer Reviewer articles because reviewer did not feel he/she had sufficient experience and knowledge to review the article.

Images in Clinical Medicine, Dermatology
Posted by Dr. Nooshin Bagherani on 25 Mar 2012 12:47:28 PM GMT

Images in clinical medicine, dermatology
Posted by Prof. Valcinir Bedin on 22 Mar 2012 06:50:52 PM GMT

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