Facing up to the Problem
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Joe R. Monroe, MPAS, PA, practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Physician Assistants.

She’s had enough of the lesions growing on her face. Will your workup help determine how to clear her skin?

Question 1 of 1

Facing up to the Problem

For several years, a 63-year-old African-American woman’s facial lesions have been slowly growing. Although they are largely asymptomatic, the patient is quite unhappy with their appearance. Additionally, she has developed respiratory symptoms of cough and shortness of breath—the latter unresponsive to antibiotics, inhalers, and a course of prednisolone.

Her primary care provider (PCP) orders a chest x-ray and a tuberculin skin test, but neither offers any diagnostic clues. The PCP tries topical steroids (0.1% triamcinolone) and metronidazole creams for the lesions, but these are of no help. The patient is then referred to dermatology for evaluation and treatment.

Examination reveals at least 3 separate pink plaques on the patient’s face. The largest, on the left medial cheek, measures 4 × 2 cm. The 2 others, located on the mid-vermillion surfaces of the upper and lower lips, are both about 1.8 cm and round.

The plaques are soft, devoid of scales or other surface disruptions, and nontender to palpation. There is no growth of follicular orifices on the surfaces of the lesions. No adenopathy is detectable in the area.

The patient appears to be in reasonably good health. She is in no distress, but she coughs frequently during her clinic visit.

The next logical step in the workup would be

A prescription for topical ivermectin

Treatment with an oral antifungal, such as terbinafine

A skin biopsy

Treatment with mupirocin

Clinician Reviews. 2019 June;29(6):8e

This quiz is not accredited for CME.

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