Dermatological Disorders

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Lectures covering the Model of the Clinical Practice of Emergency Medicine Section Week Title Topics 04. Dermatological 121 Non-Viral Skin & Soft-Tissue 04.04.01 Bacterial Disorders Infections 04.04.01(a) Abscess 04.04.01(a1) Amebic 04.04.01(a2) Community-acquired MRSA 04.04.01(a3) Pyogenic granulomata 04.04.01(b) Cellulitis 04.04.01(c) Erysipelas 04.04.01(d) Impetigo 04.04.01(e) Necrotizing infection 04.04.02 Fungal 04.04.02(a) Candida 04.04.02(b) Tinea 04.04.03 Parasitic 04.04.03(a) Lice 04.04.03(b) Scabies 10.01.06(a) Gas gangrene 11.06.01 Fasciitis 11.06.02 Felon 11.06.03 Gangrene 11.06.04 Paronychia 11.06.05 Synovitis / tenosynovitis 122 Fluid-Filled Skin Lesions Vesicular lesions Dermatitis herptiformis Dyshidrosis 04.04.04(c) Herpes simplex 04.04.04(c1) HSV 1 04.04.04(c2) HSV 2 04.04.04(d) VZV Vesicular tinea Bullous lesions Contact dermatitis Pemphigoid 04.07.01 Pemphigus vulgaris 04.07.02 Staphylococcal scalded-skin syndrome 04.07.03 Stevens-Johnson Syndrome 04.07.04 Toxic epidermal necrolysis 123 Solid, Non-Erythematous Brown & black lesions Skin Lesions Macules, papules, and nodules Dermatofibromata Freckles Lentigines Nevi 04.01.03 Melanoma Seborrheic keratoses Patches and plaques Café-au-lait patches Giant congenital nevi Generalized hyperpigmentation Skin-colored lesions Papules and nodules Rough surface Actinic keratoses Corns and calluses Warts Common warts Paronychial warts Plantar warts Smooth surface Carcinoma 04.01.01 Basal cell carcinoma 04.04.04 Squamous cell carcinoma Epidermoid cyst 04.06.02 Lipoma Molluscum contagiosum 04.03.05 Sebaceous cyst Warts Flat warts Genital warts White lesions Nodules 04.06.01 Lymphangiomata Papules Keratosis pilaris Milia Molluscum contagiosum Patches and plaques Pityriasis alba Vitiligo Yellow lesions Rough surface Actinic keratoses Crusted vesiculobullous lesions Smooth surface Necrobiosis lipoidica diabeticorum Xanthelasma 124 Solid, Erythematous, Non- Red papules and nodules Scaling Skin Lesions Papules 04.06.01 Cherry angiomata Erythema infectiosum Granuloma annulare Insect bites Pityriasis rosea Nodules Carbuncles Furuncles Hematomata Hidradenitis supprativa Inflamed epidermoid cyst Vascular reactions Transient Angioedema 04.05.06 Urticaria Persistent 04.05.01 Erythema multiforme 04.05.02 Erythema nodosum 04.05 Purpura Leukocytoclastic vasculitis 04.05.03 Henoch-Schönlein Purpura 125 Solid, Erythematous, Scaling Epithelial disruption Skin Lesions Little or no excoriations 04.03.02 Contact dermatitis Allergen Irritant 04.03.06 Seborrheic dermatitis 04.03.03 Xerotic eczema Prominent excoriations 04.03.01 Atopic dermatitis 04.03.03 Infantile eczema Lichen simplex chronicus Neurodermatitis Dyshidrotic eczema Stasis dermatitis No epithelial disruption Papules (nonconfluent) Lichen planus 04.05.04 Pityriasis rosea Secondary syphilis Plaques (confluent) Discoid lupus erythematosis Mycosis fungoides Parapsoriasis Psoriasis .

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Skin Test Christina P
SKINTEST Skin Test Christina P. Linton 1. A middle-aged, diabetic woman presents with 6. What is the estimated 5-year survival rate for well-demarcated, yellow-brown, atrophic, telangiectatic melanoma that has spread beyond the original area plaques with a raised, violaceous border on her shins. of involvement to the nearby lymph nodes (but What is the most likely diagnosis? not to distant nodes or organs)? a. Lipodermatosclerosis a. 25% b. Pyoderma gangrenosum b. 41% c. Necrobiosis lipoidica c. 63% d. Erythema nodosum d. 87% 2. Which of the following types of fruit is most likely 7. What is another name for leprosy? to cause phytophotodermatitis? a. von Recklinghausen’s disease a. Pineapple b. MuchaYHabermann disease b. Grapefruit c. Schamberg’s disease c. Kiwi d. Hansen’s disease d. Peach 8. Which of the following is not an expected 3. Hypothyroidism can cause several changes to the skin extracutaneous finding in patients with and skin appendages including all of the following, HenochYScho¨ nlein purpura? except: a. Abdominal pain a. Hyperpigmentation b. Hematuria b. Easy bruising c. Shortness of breath c. Thin, brittle nails d. Arthralgias d. Dry, coarse skin 9. When the term ‘‘papillomatous’’ is used to describe 4. In a patient with neurofibromatosis, which sign refers a skin lesion, it means that the lesion is to the presence of bilateral axillary freckling? a. characterized by multiple fine surface projections. a. Auspitz sign b. erupting like a mushroom or fungus. b. Crowe sign c. characterized by fine fissures and cracks in the skin. c. Russell sign d. sieve like and contains many perforations.
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22 Asteatotic Eczema (Xerosis, Xerotic Eczema, Eczema Craquelé, Eczema Cannalé, Eczema Hiemalis, Winter Itch)
22 Asteatotic Eczema (Xerosis, Xerotic Eczema, Eczema Craquelé, Eczema Cannalé, Eczema Hiemalis, Winter Itch) INTRODUCTION This common dermatitis is often misdiagnosed and usually overtreated. Familiarity with the physical findings will allow an accurate assessment of the underlying cause, and symptoms can usually be corrected with simple measures. The condition occurs for a number of reasons, especially the following: 1. With age, skin sebum secretion diminishes, as does the water-holding capacity of the epidermis. These changes are particularly marked on the lower extremities. 2. Bathing further depletes the epidermis of its water-retaining constituents. 3. Climate has a major effect, and most patients experience symptoms for the first time during a winter season as their skin dries from exposure to the low indoor humidity produced as buildings are heated against inclement weather. Incidence will vary from place to place, depending on the severity of the season and the overall regional weather. CLINICAL APPLICATION QUESTIONS In the early spring, a 75-five-year-old woman visits your office with a complaint of generalized itching. The symptoms began in late December on local skin areas, and have progressed throughout the winter. You suspect an asteatotic eczema. 1. What information from her history may help support your suspicions? 2. What are the primary lesions in areas of asteatotic eczema? 3. What are the secondary lesions seen in asteatotic eczema? 4. What typical configurations strongly support your suspicions? 5. This woman has minimal physical findings, and some provoking factors are evi- dent in her history, but she fails to improve with treatment. What should be done next? APPLICATION GUIDELINES Specific History Onset Symptoms usually are noted in the fifth and sixth decades of life for the first time.
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Skin Lesions in Diabetic Patients
Rev Saúde Pública 2005;39(4) 1 www.fsp.usp.br/rsp Skin lesions in diabetic patients N T Foss, D P Polon, M H Takada, M C Foss-Freitas and M C Foss Departamento de Clínica Médica. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Keywords Abstract Skin diseases. Dermatomycoses. Diabetes mellitus. Metabolic control. Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. Results High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls.
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The Prevalence of Cutaneous Manifestations in Young Patients with Type 1 Diabetes
Clinical Care/Education/Nutrition/Psychosocial Research ORIGINAL ARTICLE The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes 1 2 MILOSˇ D. PAVLOVIC´, MD, PHD SLAANA TODOROVIC´, MD tions, such as neuropathic foot ulcers; 2 4 TATJANA MILENKOVIC´, MD ZORANA ÐAKOVIC´, MD and 4) skin reactions to diabetes treat- 1 1 MIROSLAV DINIC´, MD RADOSˇ D. ZECEVIˇ , MD, PHD ment (1). 1 5 MILAN MISOVIˇ C´, MD RADOJE DODER, MD, PHD 3 To understand the development of DRAGANA DAKOVIC´, DS skin lesions and their relationship to dia- betes complications, a useful approach would be a long-term follow-up of type 1 OBJECTIVE — The aim of the study was to assess the prevalence of cutaneous disorders and diabetic patients and/or surveys of cuta- their relation to disease duration, metabolic control, and microvascular complications in chil- neous disorders in younger type 1 dia- dren and adolescents with type 1 diabetes. betic subjects. Available data suggest that skin dryness and scleroderma-like RESEARCH DESIGN AND METHODS — The presence and frequency of skin mani- festations were examined and compared in 212 unselected type 1 diabetic patients (aged 2–22 changes of the hand represent the most years, diabetes duration 1–15 years) and 196 healthy sex- and age-matched control subjects. common cutaneous manifestations of Logistic regression was used to analyze the relation of cutaneous disorders with diabetes dura- type 1 diabetes seen in up to 49% of the tion, glycemic control, and microvascular complications. patients (3). They are interrelated and also related to diabetes duration. Timing RESULTS — One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous of appearance of various cutaneous le- disorder vs.
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Surgical Removal of Epidermoid and Pilar Cysts Policy
CLINICAL POLICY ADVISORY GROUP (CPAG) Surgical Removal of Epidermoid and Pilar Cysts Policy Statement Derby and Derbyshire CCG has deemed that the surgical removal of epidermoid/ pilar (sebaceous) cysts should not routinely be commissioned, unless one (or more) of the following criteria are met: 1. The epidermoid/ pilar (sebaceous) cyst is on the face (not scalp or neck) AND is greater than 1cm diameter, 2. The epidermoid/ pilar (sebaceous) cyst is on the the body (including scalp/ neck) AND is greater than 1cm on AND the epidermoid/ pilar (sebaceous) cyst is: • Associated with significant pain, Or, • Causing loss of function Or, • Susceptible to recurrent trauma These commissioning intentions will be reviewed periodically. This is to ensure affordability against other services commissioned by the CCG. Surgical Removal of Epidermoid Cysts Policy Updated: July 2021 Review Date: June 2024 Page 1 of 4 1. Background A skin cyst is a fluid-filled lump just underneath the skin. They are common and harmless and may disappear without treatment. Cysts can range in size from smaller than a pea to a few centimetres across. They grow slowly. Skin cysts do not usually hurt, but can become tender, sore and red if they become infected. Epidermoid cysts (commonly known as “sebaceous cysts’) are one of the main types of cysts and are always benign. They are commonly found on the face, neck, chest, shoulders or skin around the genitals. Cysts that form around hair follicles are known as pilar cysts and are often found on the scalp. Pilar cysts typically affect middle-aged adults, mostly women.
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Japanese Guidelines for Atopic Dermatitis 2020*
Allergology International 69 (2020) 356e369 Contents lists available at ScienceDirect Allergology International journal homepage: http://www.elsevier.com/locate/alit Invited Review Article Japanese guidelines for atopic dermatitis 2020* * Norito Katoh a, , 1, Yukihiro Ohya b, 1, Masanori Ikeda c, Tamotsu Ebihara d, Ichiro Katayama e, Hidehisa Saeki f, Naoki Shimojo g, Akio Tanaka h, Takeshi Nakahara i, Mizuho Nagao j, Michihiro Hide h, Yuji Fujita g, Takao Fujisawa k, Masaki Futamura l, Koji Masuda a, Hiroyuki Murota m, Kiwako Yamamoto-Hanada b, Committee for Clinical Practice Guidelines for the Management of Atopic Dermatitis 2018, The Japanese Society of Allergology, The Japanese Dermatology Association a Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan b Allergy Center, National Center for Child Health and Development, Tokyo, Japan c Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan d Department of Dermatology, Keio University School of Medicine, Tokyo, Japan e Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Japan f Department of Dermatology, Graduate School of Medicine, Nihon Medical School, Tokyo, Japan g Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan h Department of Dermatology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan i Division of Skin Surface Sensing, Department
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Turkish Guideline for Atopic Dermatitis 2018
Review DOI: 10.6003/jtad.18122r1 Turkish Guideline for Atopic Dermatitis 2018 Burhan Engin,1 MD, Emel Bülbül Başkan,2 MD, Murat Borlu,3 MD, Selda Pelin Kartal,4 MD, Başak Yalçın,5 MD, Savaş Yaylı,6 MD, Server Serdaroğlu,1 MD Address: 1İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, İstanbul, 2Uludağ Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Bursa, 3Erciyes Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Bursa, 4Sağlık Bilimleri Üniversitesi, Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Ankara, 5Ankara Yıldırım Beyazıt Üniversitesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Ankara, 6Karadeniz Teknik Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, Trabzon, Türkiye E-mail: [email protected] Corresponding Author: Dr. Burhan Engin, İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı, İstanbul, Türkiye Published: J Turk Acad Dermatol 2018; 12 (2): 18122r1. This article is available from: http://www.jtad.org/2018/2/jtad18122r1.pdf Keywords: Turkish guideline, Atopik dermatit Abstract Background: Atopic dermatitis (AD) is a common inflammatory skin disease worldwide and life-long prevalence thereof can exceed 20% in developed countries. The prevalence of the disease increases gradually in developing countries and in African and Asian countries with low income. AD affects quality of life unfavorably in a significant manner. The cost of AD is quite high both due to healthcare expenses required for treatment and causing labor loss. Patients receive long-term treatments owing to the fact that it is a disease with a chronic course and there is no curative treatment which also cause medicine expenses and a number of toxicities.
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Fundamentals of Dermatology Describing Rashes and Lesions
Dermatology for the Non-Dermatologist May 30 – June 3, 2018 - 1 - Fundamentals of Dermatology Describing Rashes and Lesions History remains ESSENTIAL to establish diagnosis – duration, treatments, prior history of skin conditions, drug use, systemic illness, etc., etc. Historical characteristics of lesions and rashes are also key elements of the description. Painful vs. painless? Pruritic? Burning sensation? Key descriptive elements – 1- definition and morphology of the lesion, 2- location and the extent of the disease. DEFINITIONS: Atrophy: Thinning of the epidermis and/or dermis causing a shiny appearance or fine wrinkling and/or depression of the skin (common causes: steroids, sudden weight gain, “stretch marks”) Bulla: Circumscribed superficial collection of fluid below or within the epidermis > 5mm (if <5mm vesicle), may be formed by the coalescence of vesicles (blister) Burrow: A linear, “threadlike” elevation of the skin, typically a few millimeters long. (scabies) Comedo: A plugged sebaceous follicle, such as closed (whitehead) & open comedones (blackhead) in acne Crust: Dried residue of serum, blood or pus (scab) Cyst: A circumscribed, usually slightly compressible, round, walled lesion, below the epidermis, may be filled with fluid or semi-solid material (sebaceous cyst, cystic acne) Dermatitis: nonspecific term for inflammation of the skin (many possible causes); may be a specific condition, e.g. atopic dermatitis Eczema: a generic term for acute or chronic inflammatory conditions of the skin. Typically appears erythematous,
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Response of Ulcerated Necrobiosis Lipoidica to Clofazimine
Letters to the Editor 651 Response of Ulcerated Necrobiosis Lipoidica to Clofazimine Frauke Benedix, Annette Geyer, Verena Lichte, Gisela Metzler, Martin Röcken and Anke Strölin* Department of Dermatology, University Hospital of Tuebingen, Liebermeisterstrasse 25, DE-72076 Tuebingen, Germany. *E-mail: anke.stroelin@med. uni-tuebingen.de Accepted May 25, 2009. Sir, The patient was referred to our department with multiple, Necrobiosis lipoidica (NL) is a chronic granulomatous pre-tibial brownish-livid, bizarrely configured, partly sclerotic maculae and plaques, pronounced central atrophy and several inflammatory disease of the skin of unknown aetiology, fibrinous ulcerations. which can be associated with diabetes mellitus. NL is Chronic venous insufficiency and peripheral arterial occlusion characterized by slowly growing initially erythematous were excluded by digital photoplethysmography, arterial and plaques that turn into yellow-brown, partly telangiectatic venous dopplersonography. Laboratory tests showed normal and atrophic scars. Ulcerations occur in approximately liver enzymes, creatinine and blood count. Borrelia serology, anti-nuclear antibody screening and HbA1c were in normal 35% of cases. ranges. Microbiological swabs detected Staphylococcus aureus Many therapies have been recommended for this without clinical signs of local inflammation. chronic disease; nevertheless, therapeutic success The biopsy showed granulomatous inflammation involving the is rare. We report here the successful treatment of entire corium and the upper subcutaneous fat tissue, with homo- ulcerated NL with clofazimine, without noteworthy genous necrobiosis lined by epithelioid histiocytes, foreign body giant cells and lymphoid cell aggregates with germinal centres, side-effects. as well as lymphoplasmacellular infiltrations around the vessels. Histology thus confirmed the diagnosis of NL (Fig. 1a). As the previous therapies were without effect, we started anti- CASE REPORT inflammatory treatment with clofazimine, 100 mg/day.
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Seborrheic Dermatitis
432 Teams Dermatology Done by: Wael Al Saleh & Abdulrahman Al-Akeel Reviewer: Wael Al Saleh & Abdulrahman Al-Akeel 9 Team Leader: Basil Al Suwaine Color Code: Original, Team’s note, Important, Doctor’s note, Not important, Old teamwork 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Objectives 1- To know the definition & classification of Dermatitis/Eczema 2- To recognize the primary presentation of different types of eczema 3- To understand the possible pathogenesis of each type of eczema 4- To know the scheme of managements lines P a g e | 1 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Introduction: A groups and spectrum of related disorders with pruritus being the hallmark of the disease, they also come with dry skin. Every atopic dermatitis is eczema but not every eczema are atopic dermatitis. Atopic dermatitis mean that the patient has eczema (excoriated skin, itching and re-onset) and atopy (atopy; the patient or one of his family has allergic rhinitis, asthma or eczema). It starts early of life (eczema can happen at any time). It classified as: - Acute, characterized by erythema, papules, vesicles, oozing, and crusting. - Subacute, clinically it is represented by erythema, scaling, and crusting. - Chronic, presents with thickening of the skin, skin markings become prominent (lichenification); pigmentation and fissuring of the skin occur. Acute on top of chronic very dry 4 years old boy with chronic, itchy, well defined brownish plaque with bleeding plaques. lichenifications. Ill defined plaques Well defined erythematous excoriated Lichenification is the hallmark for plaques on both cheeks with erosion. chronic course. P a g e | 2 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Dermatitis Classification of dermatitis: Atopic, more common in children Seborrheic (oily skin)- (like naso-labial folds, scalp, ears) Contact dermatitis, substance cause eczema - Allergic - Irritant Nummular, coined shape, usually in the shin.
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Pathophysiology and Treatment of Pruritus in Elderly
International Journal of Molecular Sciences Review Pathophysiology and Treatment of Pruritus in Elderly Bo Young Chung † , Ji Young Um †, Jin Cheol Kim , Seok Young Kang , Chun Wook Park and Hye One Kim * Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University, Seoul KS013, Korea; [email protected] (B.Y.C.); [email protected] (J.Y.U.); [email protected] (J.C.K.); [email protected] (S.Y.K.); [email protected] (C.W.P.) * Correspondence: [email protected] † These authors contributed equally to this work. Abstract: Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly. Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old. The pathophysiology of pruritus in elderly is still unclear, and the quality of life is reduced. Generally, itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes. Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people. Various neuronal mediators, signaling mechanisms at neuronal terminals, central and peripheral neurotransmission pathways, and neuronal sensitizations are included in the processes causing itch. A variety of therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments. Keywords: elderly; ion channel; itch; neurotransmission pathophysiology of itch; pruritogen; senile pruritus; treatment of itch 1. Introduction Citation: Chung, B.Y.; Um, J.Y.; Kim, Pruritus is a relatively common symptom that anyone can experience at any point in J.C.; Kang, S.Y.; Park, C.W.; Kim, H.O.
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Successful Treatment of Ulcerative and Diabeticorum
Letters 1. Picardi A, Pasquini P, Cattaruzza MS, et al. Psychosomatic factors in first- Another prevalent transverse linear crease of the face, the onset alopecia areata. Psychosomatics. 2003;44(5):374-381. nasal crease, appears across the lower third of the nasal dor- 2. Vannatta K, Gartstein MA, Zeller MH, Noll RB. Peer acceptance and social sum. In some cases, changes of pigmentation, milia, or pseudo- behavior during childhood and adolescence: how important are appearance, comedones are present along the nasal crease.5 Transverse na- athleticism, and academic competence? Int J Behav Dev. 2009;33(4): 303-311. sal milia in the absence of a transverse nasal crease are less frequently reported. Recently, our research team6 reported a OBSERVATION case of seborrheic keratosis–like hyperplasia and horn cysts aligned along this crease. These findings were attributed to the Deep Labiomental Fold With Pseudocomedones fact that the triangular cartilage and the alar cartilage attach The labiomental fold is a transverse indentation of the face, in a linear fashion at the junction of the middle and lower third which marks the intersection of the lower lip and chin.1 It plays of the nose, producing a potential embryonic fault line in which a significant role in movement of the lower lip and in facial ex- retention cysts presenting as milia and comedones can occur.5 pression. We describe herein a child with a linear pattern of Early acne lesions favor the forehead, nose, and chin in microcomedones located along a deep labiomental fold. many children. Although many times overlooked, the exter- nal ear is another common location for open and closed com- Report of a Case | A 7-year-old healthy girl presented with a line edones in young patients with acne.7 We think that the com- of black papules on her chin.
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