A 38-year-old woman comes to the office because of nonpainful, nonpruritic skin lesions over her elbows for the past several months. The lesions began as small papules but have gradually enlarged. Treatment with over-the-counter emollients has been ineffective. She has no history of serious illness and takes no medications. She drinks one glass of wine 1 to 2 nights weekly; she does not smoke cigarettes or use illicit drugs. Her temperature is 37.0°C (98.6°F). Examination of the elbows shows well-defined erythematous plaques with areas of scaling. Scraping of the scales results in pinpoint bleeding. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?A. Gluten-free dietB. Oral methotrexate therapyC. Oral prednisone therapyD. Patch testingE. Topical betamethasone therapy

A 42-year-old man comes to the office due to worsening skin lesions.  Three months ago, he noticed scaly patches on his elbows, which rapidly progressed in size and number to involve other body areas.  The lesions are not painful but are mildly pruritic.  The patient also has had stiffness and pain of the hand joints bilaterally for the past 2 weeks.  He has never had similar skin lesions and has no medical conditions other than genital herpes, for which he takes daily suppressive antiviral therapy.  The patient occasionally drinks alcohol but does not use tobacco or recreational drugs.  Temperature is 37.1 C (98.7 F), blood pressure is 130/80 mm Hg, and pulse is 80/min.  Skin examination shows large, erythematous plaques covered by thick, adherent, silvery-white scales on the elbows, knees, torso, and scalp.  When the scales are removed, pinpoint areas of hemorrhage can be observed.  In addition to treating the skin lesions, which of the following diagnostic studies is most appropriate in management of this patient?

Upon assessing the patient’s back, she found an elevated skin lesion which contains fluid of inflammatory cells and is more than 1 cm. She is correct if she identifies this as a _____.*1 pointa. papuleb. plaquec. pustuled. vesicl

List two skin problems and their causes.

A 27-year-old woman comes to the physician because of multiple nontender, pruritic lesions over her face, arms, chest, and abdomen. She first noticed the lesions over her lower abdomen 5 weeks ago and says that they have since become more diffuse. She also has had fatigue and has had weight loss of 6.8 kg (15 lb) during the past 3 months. The patient has not seen a physician during the past 9 years. She has no history of serious illness and takes no medications. Her father was diagnosed with colorectal cancer at the age of 65 years. The patient drinks one to two glasses of wine with dinner nightly and smokes marijuana two to three times weekly. She has had six male sexual partners during the past 3 years and does not use condoms regularly. Her vital signs are within normal limits. Dermatologic examination shows greater than 100 flesh-colored, dome-shaped papules over the face, upper extremities, thorax, lower abdomen, and genital regions. The lesions are nontender and have areas of central umbilication. A photograph is shown.The remainder of the physical examination shows no abnormalities. Testing for which of the following conditions is the most appropriate next diagnostic step for this patient?A. Diabetes mellitusB. Epstein barr virus infectionC. Gastric cancerD. Human herpes virus 8 infectionE. HIV infection

Which is Worse?• A lesion of the ulnar nerveproximal to the elbow, orat the wrist?