You are correct. Molluscum contagiosum, a poxviral infection, is commonly observed in children. Dx is usually clinical, although in this case, a bx was performed. Pts w/ an impaired skin barrier (eg, people w/ atopic dermatitis) have a higher prevalence of molluscum contagiosum. Previous tx w/ topical steroids may exacerbate the lesions. In immunocompetent pts, molluscum contagiosum can last for an average of 1y and resolve spontaneously. Encourage pts to avoid autoinoculation and transmission to close contacts.

BMJ 2019;367:l6013

You are correct. The pt suffered from phlegmasia cerulea dolens w/ compartment syndrome of the thigh and leg. CT revealed complete clot occlusion of the L common iliac, external iliac, common femoral, superficial femoral, and popliteal veins, w/ patent inferior vena cava and R common iliac vein. The venous outflow occlusion led to compartment syndromes of all thigh and leg compartments, which was confirmed by needle manometry. The pt was anticoagulated, emergent fasciotomy was performed, and the clot was removed via catheter-directed thrombolysis. Screening for underlying malignancy or hypercoagulable state was negative, and the clot was considered to be due to May-Thurner syndrome (L common iliac vein compression by the overlying R common iliac artery).

Emergency Medicine Journal 2019;36:715-721

You are correct. A clinical dx of scabies was made based on the characteristic distribution of the rash, notably interdigital involvement, eruption on the soles of the feet, and the presence of serpiginous tracts, as well as the black dots on dermoscopy, which were the actual scabies mites. In infants, the rash may be atypical, have a polymorphic presentation, and appear similar to eczema and other skin conditions. This child improved after 2 separate courses of topical permethrin, due to inadequate application of the cream on the 1st course.

BMJ 2019;367:l5675

You are correct. Notalgia paresthetica is a clinical dx of exclusion, characterized by localized pruritus and burning, plus hyperesthesia, hypoesthesia, and/or paresthesia in a unilateral distribution in the mid-back, in dermatomes T2 to T6. These features are caused by chronic scratching and are frequently assoc w/ hyper- or hypopigmentation. Bx is not required. The other diagnoses are nondermatomal and typically occur bilaterally or have other typical features, such as central healing and edge activity for tinea corporis, or direct relation to a heat source, such as w/ erythema ab igne. There is no definitive tx. The pt was reassured by the benign and self-limiting nature of the condition. She still experiences occasional mild itching 5y later, for which she uses menthol ointment when necessary.

BMJ 2019;365:l1332