Image Challenge

Here is your challenge for today.  This tender, crusting lesion appeared on this 69 year old man 10 days ago.  It did not respond to antibiotic treatment.  He had no trauma and is healthy. What is the diagnosis?

1.  Actinic Keratosis
2.  Impetigo
3.  Squamous Cell Carcinoma
4. Candida infection
5. Inflamed Seborrheic Keratosis

Make your best choice and the answer will be posted tomorrow.

(Image from Consultant-Live)


KM said…
I'm guessing #3 Squamous Cell Carcinoma
gradydoctor said…

Whenever I think "crusty" I think impetigo. I have no idea why he wouldn't have responded to antibiotics although it could have been a treatment failure.

I'm thinking SCC shouldn't be tender, and that AK and Seb Keratosis are more hyperpigmented and shouldn't be tender either.

Have no idea why a healthy dude would have candida.

Guess, I'm going to go with impetigo. Final answer. Look forward to seeing how far off I am. :)

(Can't you tell that I just recertified for the IM boards? I'm overthinking everything!)
Jonathan said…
Cancers and keratin buildup occur relatively slowly, yet the patient was reported to have erupted "10 days ago". So, that leaves Impetigo or Candida. Impetigo affects mainly infants and children and noteworthy too the eruption didn't respond to antibiotics. That leaves Candida as a possibility. It's time for a culture.
Toni Brayer, MD said…
I love the thinking process. You diagnosticians are really doing well. Answer tomorrow!
tracy said…
Candida Infection
tracy said…
Oops, i looked up Candida and the info says it u s u a l l y responds to an antibiotic.

Anonymous said…
Can't wait to see the answer.
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