6 puzzling cases to crack

An 82-year-old woman who loved to volunteer at her local botanical garden noticed that this past summer she had developed many areas of purple ecchymosis. She told her doctor that they seemed to appear mainly on her arms and hands, where the sun was most often blazing down on her, though she was diligent about using sunscreen these days. The only change she could think of from previous summers, when she hadn’t experienced such easy bruising, was that she had started taking daily aspirin at her doctor’s suggestion.

What’s the diagnosis?

A 56-year-old woman with a history of celiac disease visited her doctor after a number of firm, smooth plaques developed over the course of a couple of weeks. They started out as yellow/pink and changed to a red color and became painful and pruritic. She noted that the lesions seemed smaller in the morning and increased in size during the day. She was also experiencing joint pain.

What’s the diagnosis?

24 hours after playing outside in the cold fall weather with her children, a 43-year-old woman with a history of systemic lupus went to the doctor complaining of palpable purpura on her hands and feet. They were painful and pruritic.

What’s the diagnosis?

A 48-year-old woman asked her dermatologist about several red lesions that were extremely pruritic. They were scattered haphazardly on the back of her leg. A few of the lesions were still smooth nodules, but others were now excoriations; she just couldn’t stop scratching them no matter how hard she tried. She estimated they had been there for nearly a month. She had a history of atopic dermatitis, but this didn’t feel like the same thing.

What’s the diagnosis?

A 38-year-old African American woman visited her doctor complaining of a cough, wheezing, and swollen glands. She also noticed that over the past month she had started to develop smooth plaques on her upper back.

What’s the diagnosis?

A 52-year-old man with type II diabetes asked his doctor about a hyperpigmented patch of skin on his neck. He had noticed it getting progressively darker over the past few months. The skin also felt a little bit thicker. Now that his dieting and exercise was finally starting to make a dent in the 80 pounds he needed to lose, he wanted to make sure he didn’t have anything else to worry about.

What’s the diagnosis?