Dr Cutitout

@schowardjd Great case

This is elkonyxis occurring in the setting of TNF inhibitor-induced paradoxical psoriasis. An adolescent male with ulcerative colitis developed a widespread psoriasiform eruption after more than 1 year of infliximab therapy. The eruption improved after infliximab discontinuation, transition to ustekinumab, & adjunctive topical roflumilast. Elkonyxis is characterized by a focal, punched-out proximal nail plate defect resulting from transient nail matrix injury and is distinct from psoriatic nail pitting, which consists of multiple small, superficial depressions. In this case, the temporal association with infliximab and concurrent paradoxical psoriasis suggests TNF-α inhibitor-induced nail matrix inflammation. TNF-α blockade may paradoxically promote type I interferon signaling, leading to activation of the IL-23/Th17 axis and development of psoriasiform disease. Sixteen weeks after switching to ustekinumab, the elkonyxis resolved, leaving only mild residual trachyonychia, supporting a medication-induced etiology.

An adolescent male w/ ulcerative colitis developed a widespread psoriasiform eruption after more than 1 year of infliximab therapy. Exam revealed well-demarcated erythematous papules & plaques w/ micaceous scale involving the scalp, trunk, flexures, & acral surfaces (~10% BSA). Nail examination demonstrated a solitary, well-circumscribed proximal nail plate defect of the left thumbnail without complete nail shedding. What is this nail finding called❔

@schowardjd Hypertrophic LP

A man in his 20s presents w/ several-mo hx of a slowly progressive, pruritic lesion on the malleolar/ankle region. Exam shows a well-demarcated hyperkeratotic, lichenified verrucous plaque w/surface thickening & excoriations from chronic scratching. What’s the diagnosis❔

@Mo7ammed_jawad6 She is such a blessing

I will not forgive anyone who sees this post and does not support me with a single word and ignores me. If you see this, leave even a dot chuffed.org/project/rafif-…

Please… take a moment — just one minute. Stop and imagine that Rafif is your daughter. Would you accept your child living in an unsafe place, without proper healthcare, education, or even the basic necessities of life? Give Rafif a path to safety — a path where she can find the things every child in this world dreams of. Donate just £1 — we are not asking for more. And if you cannot donate, please pray for us, share our story, leave a comment, and help spread hope. Rafif’s family believes in you and in the kindness of your heart, which has never let us down throughout these past 1 year and 7 months. We love you all. 💔🌸 chuffed.org/project/rafif-…

@schowardjd Erythema annul are centrifugum with trailing scale

A man in his late 50s presented w/ a 1-month hx of a pruritic rash on the right lower leg. The eruption began as a small erythematous plaque & progressively enlarged centrifugally. Initial tx by urgent care w/ topical ketoconazole resulted in marked worsening, w/ increased erythema & expansion of the lesion 🙄🤦🏼‍♂️. Subsequent tx w/ topical triamcinolone led to significant improvement. What’s the diagnosis❓

Rafif’s family is still alive.. in Gaza 🇵🇸

@schowardjd Telangiectatic macularis eruptiva acquisita (spiderangioma) from CCBs

A woman in her 60s presented w/ a several-wk hx of eruptive asymptomatic blanchable vascular papules on the face, chest, back, & UEs. She denied pruritus, pain, bleeding, or systemic sx. O/E: numerous lesions composed of a central erythematous papule w/ radiating telangiectasias. No jaundice, palmar erythema, ascites, hepatomegaly, or other stigmata of CLD. PMH -ve for liver dz, EtOH misuse, pregnancy, estrogen use, endocrinopathy, CTD, or hereditary vascular syndromes. She has been taking a CCB for HTN x10 yrs. CBC, CMP, LFTs, coagulation studies, thyroid/hormonal testing, & imaging were unremarkable. What’s the diagnosis❓

We are still alive in Gaza… 🥹🇵🇸 Despite everything, we are still trying to hold on. If you see this photo, please don’t scroll past in silence. Write anything — even a single dot means so much to us and reminds us that we are not alone. 🥹💔🙏

@Mo7ammed_jawad6 Love you Rafif

Rafif’s account is literally dying!! Please, if you see this, reply with a dot.

@dermatology Molluscum

💡 Dermatology Case Look carefully at this image. This is a case of ______. Answer = go.dermrounds.com/r/ss5Typ

@hemo_shk Herpes zoster

What is the diagnosis or description?

@schowardjd The presence of depigmentation around the facial lesion makes me favor malignant melanoma with autoimmune vitiliginous reaction. It otherwise fits in “purple plum” differential including lymphoma and Markel cell carcinoma or even leukemia cutis or cutaneous metastases.

A man in his late 60s presented w/ progressive violaceous-to-hyperpigmented patches, plaques, & tumors involving 40–50% BSA. Several tumors were present, including a large, ulcerated mass on the left cheek & an ulcerated tumor on the back. What’s your diagnosis❔

Rafif’s family is still alive.. in Gaza 🇵🇸

Support little Rafif chuffed.org/project/rafif-…

Just for the people who care about us, we are still here.♥️🇵🇸

@schowardjd Grover’s disease, MF, PRP

A man in his late 60s w/ DM, HTN, & CKD presented w/ a chronic, severe pruritic eruption. O/E: numerous 1–5 mm reddish-brown papules coalescing into plaques, diffusely involving the trunk & extremities. He denied any hx of drug hypersensitivity or recent med changes. What’s your DDx❓

@Mo7ammed_jawad6 We all love you Rafif from all over the world

We are still alive in Gaza… 🥹🇵🇸 Despite everything, we are still trying to hold on. If you see this photo, please don’t scroll past in silence. Write anything — even a single dot means so much to us and reminds us that we are not alone. 🥹💔🙏

Many people ask me why I don’t ask for donations to feed and care for Abbey. The truth is, I don’t want Abbey to be a burden on anyone. She is my responsibility, and I will do everything I can to provide for her and take care of her, no matter the circumstances. I deeply appreciate everyone’s concern, support, and kind words. Your encouragement means more to me than any donation. As long as I am able, I will continue doing my best for her.