Case StudiesDermatology

DERMATOLOGYStories From the Field

 

How clinicians are using VisualDx to identify rare conditions, manage complex cases, and educate and reassure their patients.

Sarcoidosis Uncovered: How VisualDx Guided My Diagnosis

I had a female patient in her mid-50s who presented with multiple shiny, violaceous papules and nodules on and around her nose. These had been growing for over five years, and the patient was seeking cosmetic removal. Thanks to VisualDx’s differential diagnosis tool, sarcoidosis quickly emerged as a top consideration. The concise yet thorough synopsis guided me through the diagnostic process, which can be challenging as sarcoidosis is a diagnosis of exclusion. I was able to refer the patient for an x-ray and to the appropriate specialists for follow-up, feeling confident that I had covered all the bases.

—A.G., Direct Dermatology physician assistant

Newborn Rash Mystery Solved with VisualDx

As a brand-new attending, my first case of cutis marmorata telangiectatica congenita (CMTC) walked into my clinic. It was a 2-week-old newborn with a reticulated, non-blanching vascular pattern on the left leg, present at birth. The condition didn’t change with warmth or cold, and there were no other dermatologic findings. The newborn was full term and otherwise healthy. When I examined the leg, I blanked, realizing I had seen something similar during my residency but couldn’t recall the exact diagnosis.

I asked the standard questions and told the mother I would be right back. I quickly performed a VisualDx search with the details: “Rash or multiple lesions, Lower leg, No pruritus, Patient appears well, Present at birth, Reticular configuration, < 1 month old male.” Cutis marmorta was listed as the second option, and it clicked. I reviewed the page, noted it didn’t match perfectly with symmetric presentation or persistence with warming, and then saw CMTC in the differential. After reading that page, I was confident in the diagnosis.

I was able to explain the disease, potential risks, and other findings to the mother. I felt relieved to have VisualDx as a quick and easy resource while the patient was still in the clinic.

—A.W., Yokota Air Force Base physician

Nailed It: Lichen Nitidus Confirmed with VisualDx

I recently encountered a case labeled ‘rule out measles’ from a local health agency. While it clearly wasn’t measles, I noticed monomorphic Koebnerized papules scattered across the patient’s body. With some help from VisualDx, I arrived at a diagnosis of lichen nitidus. My attending was skeptical, so we decided to biopsy, and lo and behold, it was indeed lichen nitidus. I looked awesome!

—N.J., NYU physician

Eczema Diagnosis in Skin of Color Made Easy with VisualDx

Recently, I encountered a patient with a darker skin tone who had been struggling with chronic eczema flare-ups. Diagnosing eczema in patients with skin of color can be challenging due to its varied presentation, which often leads to delays in diagnosis and management. Using VisualDx, I accessed a comprehensive library of images that accurately depicted eczema across diverse skin tones. This visual comparison allowed me to confidently diagnose the patient’s condition, which had previously been misidentified as another condition.

—V.S., Dermatology clinic physician

Misdiagnosed Fungal Infection? VisualDx Sets the Record Straight

I had a patient who came for a consultation after being aggressively treated multiple times for a fungal infection that wasn’t improving. The previous diagnoses were incorrect, as the condition was actually pityriasis rosea. I used VisualDx to show the patient various photographs of the condition, which immediately reassured him and clarified the correct diagnosis.

—A.T., San Diego Family Dermatology physician

VisualDx Helps Patient Accept Diagnosis of Tinea Versicolor

I saw a young Hispanic man with a rash on his trunk, which I diagnosed as tinea versicolor relatively quickly. Although I explained the diagnosis and treatment options, he seemed hesitant to accept the diagnosis, given that he had the rash for many years and expected a more complex discussion. I decided to show him photos from VisualDx, which displayed rashes similar to his. Seeing these images helped him accept the diagnosis more readily. In this instance, VisualDx was incredibly useful in reassuring the patient and allowing for a more focused discussion on treatment options and prognosis.

—S.S., Berman Skin Institute physician assistant

Routine Skin Check Uncovers Brain Tumor Thanks to VisualDx

My day seemed routine with skin checks, but one patient, covered in seborrheic keratoses and skin tags, had a wrinkly scalp. I casually mentioned cutis verticis gyrata, which his wife noted had appeared only a few years ago. Given that cutis verticis gyrata usually appears in teenagers, I reviewed his medical history, noting heart failure, hypertension, and diabetes. Using VisualDx, I discovered that acromegaly could be associated with his symptoms. Observing his enlarged ears, nose, and jaw, I asked if his shoe, ring, and hat sizes had increased, which he confirmed. Despite his age, his growth hormone levels were high, and an MRI revealed a brain tumor and acromegaly. He underwent tumor resection and is doing well. Though I regret not identifying the acromegaly sooner, VisualDx helped me diagnose a brain tumor during a routine skin check.

—J.M., University of Utah physician

Patient Reassurance and Clarity in Scabies Management with VisualDx

A patient came in very concerned about the possibility of scabies and asked numerous questions about how to care for her belongings, prevent spreading, and more. I used VisualDx to review the entire diagnosis with her, and the patient handout was particularly helpful. It provided detailed instructions on laundering bedding and other necessary steps. She appreciated having all the information emailed to her, which addressed any future questions she might have. Leaving the office with tangible next steps made her feel more in control of her scabies.

—S.W., West Hills Dermatology Group physician assistant

Uncovering the Rare: Diagnosing Glomangiomatosis with VisualDx

During my clinical practice, I have frequently relied on VisualDx for various cases, and one particular instance stands out. I encountered a patient with persistent pain and blue-colored nodules on their extremities. The clinical presentation suggested a vascular anomaly, but the exact diagnosis was unclear.

After entering the patient’s symptoms and visual findings into VisualDx, the differential diagnosis included glomangiomatosis, a rare and often overlooked condition. VisualDx provided comprehensive information on glomangiomatosis, covering its characteristic clinical features, imaging findings, and histopathological aspects. This guidance led me to order the appropriate diagnostic tests, including an MRI and biopsy, which confirmed the diagnosis.

—L.M., The University of Bologna resident physician

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