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Images in Clinical Medicine
Aquagenic Wrinkling of Palms in Cystic Fibrosis
Figure 1.
- May 24, 2012
- Weibel L. and Spinas R.
- N Engl J Med 2012; 366:e32
- Free Full Text
A 17-year-old girl presented with a 10-year history of transient excessive wrinkling of her palms after brief exposure to water and sweating. She reported some uncomfortable tightness of the skin during these epi¬sodes.
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Images in Clinical Medicine
“Half-Half” Blisters
Figure 1.
- May 17, 2012
- O'Connell M. and Goulden V.
- N Engl J Med 2012; 366:e31
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A 66-year-old man presented with an acute pustular eruption. On examination, an annular rash with multiple blisters was seen on the patient's trunk; the blisters contained both clear and yellow fluid. He had no associated cutaneous or systemic symptoms, ...
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Images in Clinical Medicine
Nevus Sebaceous
Figure 1.
- May 17, 2012
- Cifuentes L. and Ziai M.
- N Engl J Med 2012; 366:1923
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A 6-year-old girl who was born with a plaque on her forehead presented to the clinic. The plaque was smooth, elevated, and arranged in a linear pattern on the forehead.
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Correspondence
Bortezomib to Treat the TEMPI Syndrome
To the Editor: Recently, on the basis of a case series involving six patients, Sykes et al. described the TEMPI syndrome, a novel multisystem disease defined by telangiectasias, erythrocytosis with elevated erythropoietin levels, monoclonal gammopathy, perinephric-fluid collections, and…
- May 10, 2012
- N Engl J Med 2012; 366:1843-1845
- Free Full Text
Telangiectasias, erythrocytosis, monoclonal gammopathy, perinephric-fluid collection, and intrapulmonary shunting are characteristic of the TEMPI syndrome. A case report documents improvement with bortezomib, a drug used in the treatment of myeloma.
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Case Records of the Massachusetts General Hospital
Case 14-2012 — A 43-Year-Old Woman with Fever and a Generalized Rash
Presentation of Case. Dr. Sarah Gee (Dermatology): A 43-year-old woman was admitted to the hospital because of fever and a generalized rash. The patient had a history of atopic dermatitis and had been in her usual health until approximately 1 week before admission, when a painful, pruritic rash…
- May 10, 2012
- Mackool B.T., Goverman J., Nazarian R.M.
- N Engl J Med 2012; 366:1825-1834
- CME
A 43-year-old woman with a history of atopic dermatitis was admitted to the hospital because of fever and a generalized painful, pruritic rash involving the entire body. Examination revealed vesicles, pustules, and erosions with scalloped borders. A diagnostic test result was received.
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Images in Clinical Medicine
Eschar Formation from Testosterone Patch
Figure 1.
- May 3, 2012
- Orme C. and Imaeda S.
- N Engl J Med 2012; 366:e28
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A 78-year-old man presented for his yearly skin exam and was noted to have an oval-shaped, green-black eschar on his midback. A pink, atrophic scar was located nearby, in addition to a medicated patch of similar size.
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Images in Clinical Medicine
Lymphangioma Circumscriptum
Figure 1.
- May 3, 2012
- Tan S.-K. and Tay Y.-K.
- N Engl J Med 2012; 366:1724
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A 52-year-old man presented with a 1-year history of a vesicular rash on his scrotum. The lesions were painless, but they occasionally ruptured and drained clear fluid.
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Images in Clinical Medicine
Unilateral Dermatoheliosis
Figure 1.
- April 19, 2012
- Gordon J.R.S. and Brieva J.C.
- N Engl J Med 2012; 366:e25
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A 69-year-old man presented with a history of gradual thickening and wrinkling of the skin on the left side of his face. The physical examination showed hyperkeratosis with accentuated ridging, multiple open comedones, and areas of nodular elastosis.
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Review Article
Medical Progress: Alopecia Areata
The impact of certain skin diseases on the lives of those affected tends to be underestimated or even dismissed as simply a "cosmetic problem." Alopecia areata exemplifies such a condition, owing to its substantial disease burden and its often devastating effects on the patient's quality of life…
- April 19, 2012
- Gilhar A., Etzioni A., Paus R.
- N Engl J Med 2012; 366:1515-1525
- CME
This review article synthesizes relevant information about hair-follicle biology and pathobiology and summarizes the clinical presentation and management of this common condition.
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Original Article
Brief Report: Integrin α₃ Mutations with Kidney, Lung, and Skin Disease
Epithelial–mesenchymal interactions are important in the development and tissue homeostasis of many multicompartment organs, such as the kidneys, lungs, and skin. Adhesion of epithelial cells to basement membranes provides the structural and functional integrity of the organs. Cues from the…
- April 19, 2012
- Has C., Spartà G., Kiritsi D., et al.
- N Engl J Med 2012; 366:1508-1514
Three patients with homozygous mutations in the integrin α3 gene, a transmembrane integrin receptor subunit, were found to have disrupted basement-membrane structures causing congenital nephrotic syndrome, interstitial lung disease, and epidermolysis bullosa.
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Images in Clinical Medicine
Leonine Facies: Lepromatous Leprosy
Figure 1.
- April 12, 2012
- Salgado C.G. and Barreto J.G.
- N Engl J Med 2012; 366:1433
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A 57-year-old man presented with a 7-year history of diffuse skin infiltration associated with sensory loss in his left hand. His face had multiple nodular lesions that coalesced into plaques, especially on the forehead, ears, nose, and lips.
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Case Records of the Massachusetts General Hospital
Case 11-2012 — A 60-Year-Old Man with Weakness, Rash, and Renal Failure
Presentation of Case. Dr. Pritha Sen (Medicine): A 60-year-old man with a history of schizophrenia was admitted to this hospital in late spring because of weakness, rash, and renal failure. The patient was in his usual state of health until several days before admission, when fatigue and myalgias…
- April 12, 2012
- Channick R.N., Lorenzo M.E., Wu C.C., Hoang M.P.
- N Engl J Med 2012; 366:1434-1443
- CME
A 60-year-old man from coastal New England was admitted to this hospital because of fever, weakness, rash, and renal failure. An initial measurement of creatine kinase was 20,437 U per liter. A diagnostic test was performed.
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Clinical Problem-Solving
Skin Deep
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 56-year-old woman with symptoms…
- April 5, 2012
- Safdar N., Abad C.L., Kaul D.R., Saint S.
- N Engl J Med 2012; 366:1336-1340
- CME
A 56-year-old woman with symptoms of carpal tunnel syndrome for 6 months presented to a referral clinic with nodular lesions on her right forearm and hand and an increase in numbness and tingling in her right hand.
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Images in Clinical Medicine
Digital Mucous Cyst
Figure 1.
- April 5, 2012
- Salerni G. and Alonso C.
- N Engl J Med 2012; 366:1335
- Free Full Text
A 37-year-old man presented with a history of a solitary, round, asymptomatic nodule on his second toe. The nodule measured 6 mm in diameter and was located off the midline on the dorsal side of the second toe, between the interphalangeal joint and the proximal nail fold.
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Original Article
HLA Class II Locus and Susceptibility to Podoconiosis
Podoconiosis (endemic nonfilarial elephantiasis) is a noninfectious geochemical disease that results in bilateral swelling of the lower legs (Figure 1). It is found among subsistence farmers whose feet are exposed over many years to red-clay soil derived from volcanic rock. Podoconiosis is an…
- March 29, 2012
- Tekola Ayele F., Adeyemo A., Finan C., et al.
- N Engl J Med 2012; 366:1200-1208
Podoconiosis is a tropical form of noninfectious lymphedema associated with exposure to red-clay soil. It affects over 4 million people and is associated with substantial morbidity. In this genomewide association study in Ethiopia, associations were identified in two HLA class II loci.
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Images in Clinical Medicine
Fordyce's Angiokeratomas
Figure 1.
- March 29, 2012
- Machan M. and Tonkovic-Capin V.
- N Engl J Med 2012; 366:1240
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During a routine full-body skin examination, a 60-year-old man was incidentally found to have numerous firm purple papules measuring 1 to 2 mm in diameter and covering the scrotum.
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Original Article
Ingenol Mebutate Gel for Actinic Keratosis
Actinic keratoses are premalignant lesions that are common in light-skinned populations worldwide. In the United States, the most common form of lesion-directed therapy for actinic keratoses is cryosurgery, although other locally ablative therapies are used. In addition to potential scarring,…
- March 15, 2012
- Lebwohl M., Swanson N., Anderson L.L., et al.
- N Engl J Med 2012; 366:1010-1019
Actinic keratosis is a common precursor to squamous-cell carcinoma. Several topical treatments are effective but require weeks of application. In four randomized trials, topical treatment with ingenol mebutate for 2 to 3 days was effective in clearing actinic keratoses.
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Images in Clinical Medicine
Eruptive Xanthoma
Figure 1.
- March 1, 2012
- Kala J. and Mostow E.N.
- N Engl J Med 2012; 366:835
- Free Full Text
A 30-year-old woman with diabetes who had poor glucose control, hypertension, and hyperlipidemia was referred for evaluation of a rash of 1 month's duration. She reported no fevers, chills, or joint pain, nor had she taken glucocorticoids or had contact with anyone with similar symptoms.
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Clinical Practice
Lichen Planus
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 53-year-old…
- February 23, 2012
- Le Cleach L. and Chosidow O.
- N Engl J Med 2012; 366:723-732
- CME
- Full Text Audio
Lichen planus, an inflammatory disease, tends to affect the skin and oral mucosa but may involve the nails, scalp, esophagus, and anogenital regions. Its various clinical presentations and treatment options are reviewed, including available data to guide management.
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Images in Clinical Medicine
Spider Angioma
Figure 1.
- February 23, 2012
- Caseiro M.M. and Pinto da Costa S.O.
- N Engl J Med 2012; 366:e13
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- Video
A 62-year-old man was referred to the hepatology clinic for evaluation of elevated levels of aspartate and alanine aminotransferase, detected on routine laboratory examination. The patient reported no symptoms except for a reddish lesion on his forehead.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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