Sample Transcribed Reports:

Thank you for sending along this patient and for your helpful referral note. He presents for assessment of a recurrent dermatosis which first had its onset approximately one month ago. There do not appear to be any triggering factors at that time such as infection or new medications. He was treated with a course of systemic erythromycin and symptoms appeared to have resolved. However, he presents with recurrent pruritic plaques and wheals as well as deeper soft tissue swelling of the hands and feet. He has recently been started on Benadryl suspension with some improvement of symptoms. There have been no recent symptoms of fever, arthralgias, or other systemic symptoms. There is no past history of atopy or significant urticaria.

Exam: Revealed urticarial wheals with papules and plaques distributed over the trunk and extremities. Deeper soft tissue edema, consistent with angiodema was seen on the hands. No purpura or surface change was present.

Clinical findings are consistent with acute urticaria and angiodema. The lesions are transient and are not consistent with erythema multiforme. There does not appear to be any specific underlying etiology at present and he will start on therapy with H1 and H2 antihistamines. He will return for further review in one week.

Diagnosis: Urticaria and angiodema.

Plan: 1. Atarax suspension, 10-20 mg q. i.d.
         2. Cimetidine suspension, 300 mg b.i.d.

Thank you for referring this patient to me. He presents for assessment of dermatitis symptoms involving the trunk and extremities. He has an underlying history of ectodermal dysplasia with symptoms involving the teeth and hair. His mother states that he will sweat but she notices this primarily on the palms only. There have apparently been no previous episodes of hyperpyrexia. He has been on topical therapy with Elocom ointment with some improvement of symptoms in the past. He does not use any regular emollients. He also has an underlying history of mild asthma. Review of the family history shows ectodermal dysplasia, apparently affecting a maternal uncle as well as maternal grandmother.

Exam: Revealed a distinctive facies consistent with ectodermal dysplasia. Scalp hair was present but was slightly sparse. A conical upper incisor was present but the remaining dentition was missing. No keratoderma of the hands and feet were present. General xerosis of the skin was seen with scattered patches of dermatitis on the trunk and extremities.

The clinical findings would be consistent with hypohidrotic ectodermal dysplasia. This is inherited as an x-link recessive trait. Hidrotic ectodermal dysplasia is inherited as an autosomal dominant trait and would not be associated with teeth abnormalities. There is a risk of hyperpyrexia with hypohidrotic ectodermal dysplasia and this was discussed today with the patient's mother. He also has findings of atopic dermatitis and will start on the above topical therapy with further review in one month.

Diagnoses: 1. Hypohidrotic ectodermal dysplasia.
                      2. Atopic dermatitis.

Plan: 1. 0.1% Celestoderm cream and ointment in equal parts applied b.i.d. to areas of dermatitis.
         2. Regular use of emolients.
         3. Measures were discussed to avoid heat and irritation of the skin.

Thank you for asking me to see this pleasant patient. She presents with acute symptoms of an inflammatory plaque and subsequent ulceration developing on the anterior right lower leg, approximately two weeks ago. She describes a similar episode with an inflammatory nodular lesion developing with subsequent ulceration approximately six months ago. This subsequently showed healing over a seven-week period. She was treated with systemic antibiotics at that time, although she states that this did not appear to show any significant effect. She has also been recently started on oral Keflex therapy. She describes quite significant tenderness associated with the lesion. She has not developed any systemic symptoms such as fever or arthralgia. There is no history of underlying inflammatory bowel disease, arthritis, or other significant systemic disorder.

Exam: Revealed a 6 cm arcuate plaque. This showed a necrotic blue-grey centre with undermining as well as pustules at the periphery of the plaque. Secondary superficial ulceration was present. Healed, mildly-atrophic scars with post-inflammatory pigmentation were seen on the lateral aspect of the right leg.

The clinical findings are consistent with pyoderma gangrenosum. There does not appear to be an underlying etiology at present. She was started on the above treatment measures with further review in five days.

Diagnosis: Pyodermic gangrenosum.

Plan: 1. Investigations to include cutaneous biopsy, swab for culture, and CBC.
         2. Prednisone, 30 mg b.i.d.
         3. Topical therapy to consist of normal saline compresses followed by Polysporin ointment and non-adherent dressing.