A 53-year-old woman presented with an eruption on her face and body for 2 weeks that had developed first on the face before spreading to the trunk and extremities. There was burning with sunlight exposure. Her medical conditions included diabetes mellitus, vitamin D deficiency, and hyperlipidemia. Her treatment for the past 4 years included metformin, saxagliptin, atorvastatin, vitamin B12, vitamin D, lansoprazole, and aspirin. Because atorvastatin did not control her lipids, fenofibrate was prescribed. At 3 months, she developed photodermatitis on the sun-exposed areas of her skin and also on sun-covered areas of the chest and back. Examination showed facial erythematous scaly plaques and multiple scaly annular erythematous plaques on her trunk and extremities (Figure 1). Methylprednisolone aceponate ointment, pimecrolimus ointment 0.1%, and sunblock were prescribed. Her facial eruption was only minimally lessened, while the dermatitis worsened on the trunk, arms, and legs.

Mycosis fungoides (MF) is a neoplasm of the immune system. It is a cutaneous lymphoma originating in the peripheral epidermotropic T-cells, specifically the memory T-cells (CD45RO+). The etiology of MF is indefinite, but various factors, such as genetic and epigenetic abnormalities, environmental and occupational exposure to chemicals, infections, and cytokines (interleukin [IL]-2, IL-4, etc.), play a vital role. Pityriasis lichenoides (PL), such as MF, is a rare subtype that is presented with skin lesions similar to that of PL.

A 64-year-old man participated in a 13.1-mile half marathon in San Diego, CA on April 23, 2023. The ambient temperature when he started the race was 54°F, which increased to 64°F on his completing the race 3 hours and 58 minutes later. Both of his hands and their digits started swelling after the first hour of running. They progressively became larger during the remainder of the race; a positive fist sign developed and the patient could not close his hands into a fist (Figure 1). Neither pruritus, swelling at any other site, nor angioedema was reported.

A 39-year-old woman presented to the dermatology department in January 2022 with a 3-week history of a progressively enlarging and intensely pruritic erythematous annular nodule on her left hand. The lesion started as a small blister, which was initially presumed to be a flare up of her pompholyx dermatitis. On her physician's advice, she applied clobetasol propionate ointment twice daily for 5 days; however the blister continued to increase in size until it burst, revealing raw inflamed skin. As the patch continued to increase in size, she was prescribed oral ciprofloxacin 500 mg twice a day for 5 days; however, the constantly weeping lesion grew to around 3 cm in diameter. The associated pruritus also became intense, without any response to regular antihistamines and ice application and disturbing patient's sleep. She also applied regular povidone iodine dressings but without any effect. Apart from pompholyx dermatitis, her medical history was significant for hypermobile Ehlers Danlos syndrome type 3 (hEDS).

The 73-year-old non-Hispanic, African-American man with a history of renal cell carcinoma (RCC), status post-nephrectomy receiving Lenvatinib, and metastatic disease, for which he also had received nivolumab for 13½ months. An itchy eruption appeared one month after the discontinuation of nivolumab and after the beginning of axitinib therapy. Physical examination revealed pink-violaceous scaly plaques, some with trailing scales on the anterior aspect of the trunk (Figure 1), a slight erosion on the hard palate, and hypopigmentation on the hands and legs. A punch biopsy revealed spongiotic and interface dermatitis, suggesting a drug eruption. The patient was treated with triamcinolone 0.1% ointment and prednisone 60 mg, with resolution of the eruption. Because the treating oncologist was concerned that the dermatitis was caused by axitinib, the patient was switched to tivozanib; however, the patient developed a new bullous eruption two months after starting tivozanib. Physical examination revealed small papules on the hands, pink patches on the trunk, and small round crusts and tense lesions on the arms (Figure 1).

A 15-year-old African-American man (Fitzpatrick skin type V) presented to the outpatient dermatology clinic with a large, verrucous, exophytic mass measuring 3.5 × 2.3 cm on the right lateral side of the posterior flank (Figure 1). The lesion had been increasing in size for several years. His mother had refused a shave excision when he was 9 years old. He also had atopic dermatitis, acanthosis nigricans, and benign melanocytic nevi. He was obese with borderline hypercholesterolemia.

A 63-year-old man, with no past medical history, presented with an asymptomatic, progressively evolving polypoid lesion for 2 years in the left ciliary region. Physical examination revealed an exophytic tumor lesion of firm consistency and lobulated surface, with regular and well-defined borders. It measured 2 cm in diameter, and had a brownish-violet coloration with whitish areas (Figure 1).