This nodule on the neck is a typical location and appearance for an epidermal cyst. If the cyst has never been inflamed or infected, it may be removable through a very small punch biopsy followed by lateral pressure or a small linear incision.
In the current milieu, the clinician should assume that MRSA is responsible for furuncles, until culture proves otherwise. Incision and drainage is the most important part of therapy, but oral antibiotics should be considered in large lesions, very young or very old patients, and when cellulitis surrounds the boil.
This biker asked that his wound be rinsed with hydrogen peroxide, which is now felt to be irritating to tissue and no longer recommended for use in rinsing out a traumatic wound. Water or saline is preferable. Also, superficial abrasions heal better when kept moist.
It is rare for acne of this severity to develop in normal, healthy adults. This picture strongly suggests patient manipulation of more minor lesions. When the clinical picture is unusual or improbable, always consider the possibility of factitious disease.
This is a classic keratoderma, which can be due to a variety of congenital defects in keratinization or acquired in association with disease states. Retinoids, systemic and topical, are the treatments of choice.
This solitary, very pruritic, annular lesion suggests dermatophytosis. KOH preparation verified the presence of Tinea faciei. This infection is usually associated with contact with a new kitten or puppy.
This clustered grouping of small, shallow erosions surmounting a slightly indurated plaque is characteristic for “cold sores.” Because no vesicles were present and the lesions appeared to be crusting over, the patient was advised to apply an OTC cream (docosanol 10%) per package insert instructions.
These small, pruritic papules appeared in the morning, which strongly suggests the bite of a nocturnal feeding arthropod. Insect bites arranged in clusters of 3 is typical for, but not diagnostic of, bedbug infestation.