Rash and dysuria

48y, fork-lift operator, h/o tobacco and alcohol abuse, f/h of CAD and DM, recently diagnosed with HTN, comes in with dysuria, redness and irritation over the glans penis and discomfort on trying to retract the foreskin. These symptoms started about 4 days ago. He has been in a monogamous relationship and hasn't been sexualy active for over 6 months. He has been on HCTZ 25mg for about 6 weeks and was recently prescribed viagra for ED. On exam, the glans penis appears very erythematous, the prepuce non-circumcised, erythematous, with fissuring. Urine analysis showed 1+ protein and approximately 250mg% of glucose without any RBC or WBC. Random blood sugar was 201. His last meal was about 3 hours ago.
Which of the following treatments is most likely to be successful?

1. Topical Clotrimazole 1% bid and wash with warm water 4-5 times/ day- ANSWER.
2. Topical Triamcinolone 0.1% bid.
3. Stop HCTZ and Viagra- this is possibly fixed drug eruption
4. Cefixime 400mg po x 1 and Doxycycline 100mg bid x 7 days
5. Pimecrolimus 1% topical bid

Dry soles

25 y, white man, presents to the office with excessively dry soles, a problem for the past 7 years. He complains of excessive sweating restricted to his feet. It seems to impair is daily activities and sometimes needs to change his socks several times in the course of a day. He acknowledges exacerbation of his symptoms in stressful situations and in summer. He denies nocturnal sweats, fever, cough, anorexia, wt loss, skin rash, arthralgias, anxiety or depression. He denies travel or exposure to new chemicals. None of the over the counter remedies seem to help. He has seen multiple physicians for the problem with no avail. He does not take any medications. On exam, his vital signs are stable. He has excessively dry and macerated soles. No involvement of palms or axillae is noted. What is the most likely diagnosis?

1. Icthyosis
2. Tylosis
3. Bazex’s syndrome
4. Focal hyperhidrosis- ANSWER
5. Undiagnosed anxiety disorder
6. Hyperthyroidism

Warty growth on the scalp!

50 y white man, with no PMH, presents to the office with a growth on the scalp for several years. On exam, the patient has a 2 cm filiform eruption on the scalp. What is the most likely clinical diagnosis?

1. Verruca vulgaris- answer
2. Squamous cell carcinoma
3. Basal cell carcinoma
4. Actinic keratosis
5. Keratoacanthoma