Challenging Cases from the Clinic

Panel Discussion: Challenging Cases from the Clinic by Adam Friedman MD, John Koo MD, and Craig Teller MD

• Neutrophilic dermatoses are often associated with hematologic malignancies. Communicate with PCP and check SPEP, UPEP, and CBC. Dapsone is the treatment of choice.
• If delusions of parasitosis patient insists on you looking at "specimens", send them home with glass slides to collect them and instruct them to cover with clear packing tape (not scotch tape). This will save you time in clinic and demonstrate to the patient that you are open-minded. If they push for a biopsy, allow them to pick the location they are sure their parasite resides with a verbal agreement to consider other options when the biopsy does not show parasites.
• Sarcoidosis pearls: Fair skin types will typically present with pink or red lesions, while those with darker skin types with present with purple or brown lesions. Trachonychia is a common feature of sarcoidosis, but is almost never seen as a stand alone presentation without other skin lesions. Also keep in mind that sarcoidosis can occur in sites of botulinum toxin injection, tattoos, or piercings.