A 45-year-old woman comes to the physician for evaluation of lesions on her chest and axillae. She initially noticed a small papule at her right axilla 6 months ago, followed by additional lesions in the same area extending toward her right breast. There is no associated pain, erythema, discharge, or pruritus. The patient is concerned about the number of lesions and requests further evaluation. She has a history of asthma treated with an albuterol inhaler as needed. She does not use tobacco or alcohol. Her vital signs are within normal limits. Skin examination of the right axillary region is shown below. The remainder of her physical examination is normal. Which of the following is associated with this patient's skin condition?

Question

A 45-year-old woman comes to the physician for evaluation of lesions on her chest and axillae.  She initially noticed a small papule at her right axilla 6 months ago, followed by additional lesions in the same area extending toward her right breast.  There is no associated pain, erythema, discharge, or pruritus.  The patient is concerned about the number of lesions and requests further evaluation.  She has a history of asthma treated with an albuterol inhaler as needed.  She does not use tobacco or alcohol.  Her vital signs are within normal limits.  Skin examination of the right axillary region is shown below.  The remainder of her physical examination is normal.  Which of the following is associated with this patient's skin condition?

Quizplus · Accepted Answer

Explanation: 11ec2b69_be6d_5777_8f63_cb601deb20df_MD0005_00 This patient's skin lesions are consistent with acrochordons (skin tags), benign outgrowths of normal skin. Acrochordons usually appear as pedunculated, skin-colored papules, most commonly in areas of friction (eg, axillae, neck, inframammary, inguinal regions). Up to 25% of adults have skin tags, and they occur more frequently with age. Many studies have noted an association between skin tags and obesity, insulin resistance, overt diabetes, and metabolic syndrome. Skin tags also occur more commonly during pregnancy and in patients with colonic polyps. Diagnosis is based on clinical appearance. Skin tags do not usually require treatment, although it may be considered if there is associated irritation or for cosmetic reasons. Treatment options include snip excision or cryosurgery. (Choice A) Celiac disease is associated with dermatitis herpetiformis, which appears as pruritic, erythematous, and grouped papulovesicular lesions. dermatitis herpetiformis (Choice B) Crohn disease is associated with perianal skin tags rather than axillary skin tags, as seen in this patient. Crohn disease is also associated with pyoderma gangrenosum, which presents as a purulent ulcer. perianal skin tags pyoderma gangrenosum (Choice C) Hepatitis C is associated with lichen planus, porphyria cutanea tarda, and cryoglobulinemia causing leukocytoclastic vasculitis. However, these lesions usually do not appear as pedunculated skin masses. lichen planus porphyria cutanea tarda leukocytoclastic vasculitis (Choice D) Acute HIV can present with a generalized rash appearing as small and well-circumscribed red macules or papules. Chronic HIV has been associated with a variety of skin lesions, including molluscum, Kaposi sarcoma, and recurrent herpes zoster. molluscum Kaposi sarcoma herpes zoster Educational objective: Acrochordons (skin tags) are benign outgrowths of normal skin that appear as pedunculated, skin-colored papules in areas of friction. Skin tags are associated with obesity, insulin resistance, overt diabetes, and metabolic syndrome. References: Skin disorders in overweight and obese patients and their relationship with insulin. (http://www.ncbi.nlm.nih.gov/pubmed/24238328) Acrochordons as a cutaneous sign of metabolic syndrome: a case-control study. (http://www.ncbi.nlm.nih.gov/pubmed/24761238)

A 45-Year-Old Woman Comes to the Physician for Evaluation of Lesions