Simple cases

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Case 18


I have some blue spots on my groin, scrotum and belly button. They are new and the same areas itch.

The blue spots (maculae ceruleae or taches bleues) are highly diagnostic.

For about 6 weeks. I kept thinking they would disappear, but I keep getting more.

This slow spread is typical. This dermatosis often remains unnoticed for weeks.

I have no idea—we are separated.

Important question, as in adults the causative agents are usually transferred by sexual contact.

Yes, I was in Cuba 2 months ago and had sex few times.

Important question, as in adults the causative agents are usually transferred by sexual contact. This dermatosis may be a sign of promiscuous behavior.


Good question. Often patients have more than one sexually transmitted disease at the same time.

Is that really necessary? Are these spots connected with AIDS? I always use a condom.

Since this dermatosis is acquired sexually, HIV testing is important. Take time to explain the situation to the patient.

Choose the right efflorescences:

False. No fluid-filled lesions are present.

False. No scales are seen.

These small blue lesions are flat and thus macules. They are caused by small amounts of old blood in the dermis following lice bites.

Choose the right diagnosis:

False. The exanthem of secondary syphilis is more widespread and the patient is usually sick. But syphilis screening is important in this case.

Senile angiomas are usually ruby red papules on the trunk.

Correct. The pubic lice are transferred by sexual contact, spread slowly and leave behind maculae ceruleae when they bite and feed. They typically involve pubic hairs, but occasionally are found in the axillae or on the eyelashes.

False. These are not signs of AIDS, but because the lice are transmitted during sexual contact, HIV screening is important.

Choose the right therapy(ies):

False. Topical antibiotics are not useful here.

Good. Lindane is also effective against pubic lice.

Although impossible in this case, always desirable. Only so can the spread of the lice be interrupted.

Correct. Clothing and bedding must be washed at a high setting.

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