If certain drugs give you petechial marks, you need to avoid these medicines. Microdermabrasion: a molecular analysis following a single treatment. Biopsy exposure to fluorescein-labeled antibodies directed against IgG, IgM, IgA, C3, and polyvalent immunoglobulins (IgG, IgM, and IgA) yielded no immunofluorescence. Went to grandkids soccer. Depending on the size of the treatment area, the entire procedure will last between 3060 minutes. Retrieved from, Lloyd, J. R. (2001, April). Therefore, its best to use Encyclopedia.com citations as a starting point before checking the style against your school or publications requirements and the most-recent information available at these sites: http://www.chicagomanualofstyle.org/tools_citationguide.html. Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. So why did I buy the kids? Petechiae are tiny red dots that appear when capillaries bleed and cause blood to leak into the skin. Petechiae after scratching. Microdermabrasion is a cosmetic treatment with an excellent safety profile for people of all skin types and colors. Two days later, the spots appeared within the most severely sunburned areas of both legs. Waters AJ, Sandhu DR, Green CM, et al. The development of a petechial rash 24 hours following a mRNA immunization might suggest preexisting immunity to the SARS-CoV-2 virus. This site needs JavaScript to work properly. From the University of Vermont Medical Center and the University of Vermont Larner College of Medicine, Burlington. Kalivas J, Kalivas L. Solar purpura appearing in a patient with polymorphous light eruption. CBC showed normal white blood cell count, normal hemoglobin/hematocrit, normal platelet count. can result in the breakage . I don't know all about your treatment, but if you are just beginning Tamoxifen, I assume you had radiation recently. I had #30 sunscreen on but could only be out in the sun for 20 min. You may experience some dry, flaky or itchy skin in the immediate days following microdermabrasion. A petechial hemorrhage is a tiny pinpoint red mark that is an important sign of asphyxia caused by some external means of obstructing the airways. Petechiae are small, pinpoint-sized red dots on the surface of the skin. [CDATA[ Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. Adhering to a consistent treatment plan that allows your skin enough time to heal between sessions is crucial to obtaining ideal results. I found lots of info online I found lots of info online about Tamoxifen and sun sensitivity; this one seems pretty much right to the point! His platelet count was low at 110 103 per L (110 109 per L), but findings on a complete blood count and basic metabolic panel were otherwise normal. B., & Spandau, D. F. (2014). References Thomas Angela E, Baird Susan F, Anderson Julia. Medical Definition of Petechiae. You can expect your photosensitivity to last for about three weeks. Different conditions, ranging from mild, preventable diseases, life-threatening illnesses, and prescription drugs, can cause this bleeding below the skin or mucous membranes. Wrinkling of the skin, especially around . Petechiae worsened over the next several days and she developed left lower leg swelling, paresthesia in left lower leg, and dizziness, and the patient went to ER. I did use sunblock, and I'm generally a 'dark tan' skin type but it looks like my days of relaxing in the sun are limited and change is in order for the next five years :-/, one search in google brought up multiple links to 'tamoxifen and Sun Senditivity'. Review our cookies information for more details. It's also a common symptom to have after you've given birth. Retrieved February 22, 2023 from Encyclopedia.com: https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/petechial-hemorrhage. petechiae and mucosal bleed-ing. They may also occur inside the mouth or on the eyelids. Although gentle, microdermabrasion still wounds the skin by removing its surface layer. The Royal Childrens Hospital Melbourne. Knight's Forensic Pathology. IV. petechial. No rash. Medications that commonly cause leukocytoclastic vasculitis include beta-lactam antibiotics, sulfonamides, thiazides, allopurinol, and quinolones. Ann d'Hyg Publ Med Legal. We refer to them in plural because they are barely seen individually and they are usually displayed in clusters. IgA vasculitis often resolves in one to two months without treatment. A petechia, or more commonly used in Latin plural, petechiae, are microscopically small dots which appear beneath the skin surface in red, brown or purple color. She said the hat would look perfect with my red cowboy boots (which another friend had given me to kick cancer's butt). Cite this article Pick a style below, and copy the text for your bibliography. Accidental and non-accidental Injuries can cause bleeding, which can lead to petechiae. MyVision.org is an effort by a group of expert ophthalmologists and optometrists to provide trusted information on eye health and vision. The bleeding causes the petechiae to appear red, brown or purple. The pityriasis rosea rash went away after 4-5 weeks, but I also noticed some little red dots on my torso (and it seems I have a few on my chest and a couple on the right arm . You did not mention complement studies as there may have been an associated consumption of complement. Often they are seen in the conjunctiva of the eyes and also on the eyelids, especially after hanging. Urinalysis revealed 10 to 25 red blood cells per high-power field without protein. Ztopkov L, Jank M, Urbanov P, Mottlov J, Hejna P. Forensic Sci Int. Recent laboratory tests were negative for hepatitis. ." A question was posed about a friend on Tamox and sun exposure. By continuing to browse this site, you are agreeing to our use of cookies. His physical examination was otherwise unremarkable, including normal vital signs. Microscopic examination revealed reactive epidermal changes with mild vascular ectasia and erythrocyte extravasation not associated with appreciable inflammation or evidence of vascular injury (Figure 2). Four to six microdermabrasion sessions are generally required for best results. Fever With Petechiae In An Infant: Diagnostic And Treatment Conundrum. 2023 Copyright Derm Collective. This treatment can address the same skin conditions as microdermabrasion, but is considered even more gentle. The fact that we have also had radiation also adds to the equation. chia p-t-k-. Petechial hemorrhages on the face are also found in other conditions such as cardiac arrest. Family Medicine 26 years experience. Most procedures, as a rule, carry greater risk of adverse effects for darker skin types, explains Dr. Downie. The noose compre, CORONER The Royal Childrens Hospital Melbourne. PICTURES. Petechial skin changes acutely following intense sun exposure is a rare phenomenon referred to as sunburn purpura, photolocalized purpura, or solar purpura. Keep the cupping marks covered - Keep the area covered with loose fitting clothing. This drug causes skin sensitivity to sun and women who are using this medication need to wear sun protection factor 30 and higher to protect themselves from suns influence. Vaccinations can be associated with flares of autoimmunity although this is controversial as well. His long-term medications were insulin degludec (Tresiba), semaglutide, and lisinopril. Avoid close interaction with individuals who appear sick, as some viral causes of petechiae are contagious. Please review our about page for more information. Prolonged straining (vomiting, coughing, sneezing, getting choked) can cause this bleeding.". It would start on my feet and go up my ankles. 57,female: 20: early relapse: . In 265 cases of hanging, we retrospectively examined whether petechiae relate to type of suspension, body weight and height, body mass index (BMI), age, sex, type and thickness of the ligature, and blood alcohol content. Her sis had died 4 days beforeso there was more crying than usual in the Hallmark aisle that day. They are sometimes also called petechiae. IgA vasculitis, formerly known as Henoch-Schnlein purpura, is a systemic small-vessel vasculitis characterized by deposition of immune complexes containing IgA. "Concerning Tamoxifen, your friend should know that sun exposure should be avoided and protective clothes worn when in the sun. Forensic Sci Med Pathol. Prolonged straining (as a result of chronic coughing, vomiting, giving birth, etc.) Follicular hyperkeratosis. what does hong kong flight departure mean shein. Like other side effects, bruising should clear up within hours to a day after treatment. Enfermedades de Inmunodeficiencia Primaria, AAAAI Diversity Equity and Inclusion Statement, Petechial rash after mRNA COVID-19 vaccine. I will make an extra effort to stay under wraps when outdoors. Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out by a health care provider. In addition, use liberal amounts of sunscreen with at least SPF 30 protection for about three weeks following a session. ITP is characterized by increased bleeding, commonly presenting with flat/non-palpable petechiae and mucosal hemorrhages, and in some patients, urogenital bleeding and increased menstrual. If you have a rash from a tanning bed, you'll recognize it from some common symptoms. Dermabrasion and microdermabrasion. See permissionsforcopyrightquestions and/or permission requests. Share on Facebook . This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor. However, if the patient did not have prior COVID-19 with pre-existent immunity, the timing is not consistent with an anti-viral immune response as longer time would have been required. The forensic pathologist usually needs a very good light source and maybe even a magnifying glass to detect petechial hemorrhages. 2016 Dec;37(4):299-305. doi: 10.1097/PAF.0000000000000270. Sepsis can also cause end-organ damage, especially to the kidney and liver. One week prior to presentation she had a severe sunburn affecting most of the body, which resolved without blistering. Petechiae is a medical term for small, red marks under the skins surface, says Dr, Downie. Petechiae and purpura are common when the platelet count is severely low, whereas systemic symptoms, such as arthralgias or abdominal discomfort, are not present. Chronic UV exposure has been linked to increased skin fragility and the development of purpuric lesions, a benign condition known as actinic purpura and commonly seen in elderly patients. In most cases, petechiae will not require any specific treatment. If your skin tone is not restored after healing, your doctor may recommend or prescribe topicals, ointments, creams or other procedures. Planning to head to Florida myself when treatments are done, so I at least am glad to hear it is still the "Sunshine State,". I started Tamoxifen in mid-March and had no idea about sun sensitivity. Despite being an ablative cosmetic procedure in which a layer of skin is physically removed, the risk of side effects is low, and those side effects that may appear are mild and temporary. Figure 1. Some patients, especially those with darker skin tones, may notice some temporary pigment changes or skin discoloration following microdermabrasion. [2] And, guess who gave it to me? Prolonged straining Tiny petechiae of the face, neck and chest can be caused by prolonged straining during activities such as coughing, vomiting, giving birth and weightlifting. Microdermabrasion is a skin rejuvenation procedure that physically exfoliates the skin by peeling away the stratum corneum, or outer layer of skin. They generally have lengths of between 1 and 2 millimeters. If need be . Petechial skin changes acutely following intense sun exposure is a rare phenomenon referred to as sunburn purpura, photolocalized purpura, or solar purpura. Usually, the dot or patch is well beneath the surface of the skin, but just occasionally it might bleed. The treatment for rashes and infections depends on the specific type of infection transferred to you, such as acne. Thrombotic thrombocytopenic purpura (TTP) is an uncommon and potentially lethal microangiopathy that carries a >90% mortality rate if not treated urgently and appropriately. If you have oily or combination skin, dry skin may not be as apparent, but you may notice a temporary reduction in oil after a microdermabrasion session. Petechiae: Pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage (bleeding into the skin). The site is secure. Don't expose the area to sunlight, and don't bathe or shower. Idiopathic sunburn purpura should only be diagnosed after other conditions are excluded. Petechiae and purpura are common when the platelet count is severely low, whereas systemic symptoms, such as arthralgias or abdominal discomfort, are not present. Loesch, M. M., Somani, A. K., Kingsley, M. M., Travers, J. Understanding the Epidermal Barrier in Healthy and Compromised Skin: Clinically Relevant Information for the Dermatology Practitioner: Proceedings of an Expert Panel Roundtable Meeting. I feel like I've been there, done that and totally have the scars to prove it! I'm not usually sensitive to the sun and don't usually burn so easily. While some bruising is unavoidable, its severity is dependent on the skill of the devices operator. MDedge: Keeping You Informed. Potential complications include: Prevention of petechiae requires you to understand the possible causes and avoid them. Most importantly, the nonspecific biopsy findings and unremarkable laboratory findings associated with our case may represent primary or idiopathic sunburn purpura. Altered mental status, including confusion and loss of consciousness, Petechiae without any apparent cause like trauma. Leung AK. (December 2019). A reanalysis of a study of real-world vaccination outcomes from Israel." Pin-sized reddish-purplish spots called petechiae can appear on the skin. Palpable purpura is purpura than can be felt, due to inflammation of the blood vessels ( vasculitis) Book now for $1000 off LASIK + Affordable Financing Options Available, Clinical Practice Guidelines-Petechiae and Purpura. While common, petechiae is only a minor cosmetic concern that can often be concealed using makeup after your skin begins to heal roughly 24 hours after your procedure. Following investigations, your doctor might identify a specific cause of the petechiae and recommend the appropriate therapy, which can be: While the petechial lesions usually heal without scarring, the underlying conditions can result in complications if not treated appropriately. Exercise-associated solar purpura in an atypical location. Am J Forensic Med Pathol. In summary, I would obtain a CH50, C4, C3, ESR, CRP, urine analysis and ANA and continue to monitor the patient. noticed 2-3 weeks ago that my skin was itchy & after scratching petechiae appeared. Body mass index was the only variable able to add information to the type of suspension. For example, petechiae can appear after straining to lift heavy weights. The lesions were mildly tender to palpation. MedicineNet. Secondly, tannings beds can deliver a better-looking tan compared to other tanning methods. If skin is very dry you can use an oil in the morning under your moisturiser as the skin will soak it up very quickly. Refer to each styles convention regarding the best way to format page numbers and retrieval dates. All my best. Petechiae are small, purpuric lesions up to 2mm across. 24 hours after the first Pfizer COVID-19 vaccine, the patient developed petechiae on the left lower leg. Petechiae are sometimes caused by intense straining and often appear around the eyes or on the chest. You should contact a doctor when you or your child develops non-blanching red spots of less than 2 mm with any of the following associated symptoms: Infections by bacteria and viruses remain the leading cause of petechiae among different age groups. However, patients with dark skin who undergo microdermabrasion may be slightly more at risk of developing mild and temporary side effects. They can be caused by a simple injury, straining or more serious conditions. Fatal pressure on the neck. The manifestations appear to be vasospasm but are associated with petechiae. After a microdermabrasion session, your doctor or esthetician will apply a moisturizer to the treated area. Sepsis resulting from the spread of bacterial infections to different organs. Fever With Petechiae In An Infant: Diagnostic And Treatment Conundrum. Retrieved from. After only one minute of inversion, the resultant ocular findings included orbital In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. 3. We prefer the term sunburn purpura because it reflects the acuity of the phenomenon, as opposed to the previous labels solar purpura or photolocalized purpura, which also could suggest causality from chronic sun exposure. Tan, M. H., Spencer, J. M., Pires, L. M., Ajmeri, J., & Skover, G. (2001, November). Karimipour, D. J., Kang, S., Johnson, T. M., Orringer, J. S., Hamilton, T., Hammerberg, C., Fisher, G. (2005, February). Because the epidermis isnt compromised, there are no long-term complications arising from this procedure. I'm wearing it to the Relay for Life later in June. Flat, nonpalpable, and circumscribed; less than 1 cm in diameter; brown, red-purple, white, tan; Elevated, irregular-shaped area of cutaneous edema; solid pale pink with light center. Hunter, Paul R., and Julii Suzanne Brainard. For those who don't know, petechiae are dots of blood which appear under the skin; they often appear with purpura, which are larger areas or patches of blood under the skin, rather like a bruise. JON M. SWEET, MD, AND BENJAMIN H. MULKEY, MD, Carilion Clinic, Roanoke, Virginia. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide athttps://www.aafp.org/afp/photoquizinfo. The content on this site is for informational purposes only. Should there be any further workup for petechiae? Patient is asking if it is okay to receive the second vaccine. (January 2018). Cavalier Aircraft For Sale; How Many Hyenas Are Left In The World; Cole County, Mo Ordinances; Cerner Acquired Siemens Health Services; Mcdonald's Disney Glasses Lead petechiae after tanning. World of Forensic Science. They can appear as red, brown or purple lesions that do not disappear when squeezed. Signs of petechiae may remain for up to two weeks after treatment. Itchy as heck and I had to get a special medication to alleviate the symptoms. Luckily, I have worn sun hats for several years so that habit shouldn't be hard to continue. If petechial hemorrhages and facial congestion are present, it is a strong indication of asphyxia by strangulation as the cause of death . Drs. Ros AM. Petechiae in hanging: a retrospective study of contributing variables. Purpuric and petechial rashes in adults and children: initial assessment, American Society of Hematology 2019 guidelines for immune thrombocytopenia. https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/petechial-hemorrhage, "Petechial Hemorrhage And I wanted spray on because I hate smearing stuff on me.Also, in the "I'll find the good in this cancer cr*p department", our Walgreen's sells Hallmark cards. If your doctor recommends monitoring of the lesions without prescribing any medications, it is likely that your condition is mild and will resolve on its own. I was out for a walk yesterday and later in the evening realized I had sunburn on both arms. Optimization of microdermabrasion for controlled removal of stratum corneum. The oncologist said it was from the chemo, so I suppose Tamoxifen could make you sun-sensitive, too. Use of this Web site is subject to the medical disclaimer. These spots are non-blanching as they do not disappear on applying pressure. Identify the layers of the skin. Both petechiae and purpura are non-blanching spots. Lesions of macular purpura are larger than petechiae but smaller than ecchymoses. Bethesda, MD 20894, Web Policies An official website of the United States government. Encyclopedia.com. However, they are neither bumpy nor itchy like most rashes. Guess what's sitting on my head right now? (Oh, and I never allow myself to go into my room, curl up in a ball on the bed, and vow never to leave that position. Microdermabrasion is performed with one of two types of handpieces: A vacuum device is also attached to each device, which serves the purpose of suctioning up dead skin cells, dirt, oil and other debris from the skins surface. Clinical Practice Guidelines-Petechiae and Purpura. p-t-k-l. Retrieved from. . My sisters and I decided a break from all of this was in order, so off to the Florida gulf we went! All Rights Reserved. Statistical analysis showed that incomplete suspension was significantly stronger related to the development of petechiae than complete suspension. Types of physical trauma that can result in petechiae include: Car accident. Guarrera M, Parodi A, Rebora A. Society of Critical Care Medicine. plural petechiae p-t-k-. Patients who undergo microdermabrasion can expect a simple, quick and gentle procedure to rejuvenate the skin, with little risk of significant adverse reactions. Therefore, that information is unavailable for most Encyclopedia.com content. Given the patient's normal platelet count, a diagnosis of idiopathic sunburn purpura was made. Lastly, tanning sessions are quite affordable compared to in-office phototherapy sessions. American Society of Hematology. The investigations for the diagnosis of petechiae are as varied as the causes themselves. Low platelet counts can predispose patients to mild to severe bleeding inside the body or under the [] Best of luck with your journey.BL, im newly diagnosed this year and post surgery have only been on Tamixifen for about 3weeks. Most online reference entries and articles do not have page numbers. They may also be found elsewhere on the skin of the head and face, such as in the mucous membrane inside the lips and around or behind the ears. IgA vasculitis is often preceded by an infection, such as an upper respiratory tract infection. Markers of inflammation like CRP and procalcitonin can also be useful. 1829;31(99):229250. sharing sensitive information, make sure youre on a federal I had that during my radiation treatment. The https:// ensures that you are connecting to the Petechiae can show up both on dogs' mucous membranes and on their skin. Dr. Edmond Bendaly answered Hematology and Oncology 22 years experience Unlikely petechiae: Those are unlikely to be petechiae. I personally would not favor repeat vaccination with the Pfizer or other COVID19 vaccines, but I think there could be a discussion and repeat vaccination, with the Pfizer or an alternative vaccine. Various issues can cause these tiny spots to appear. Internal examination may reveal petechiae on the surfaces of the lungs and heart in cases of death by heat stroke Zufall said that massaging from the center of the face to the edge, then down toward the neck, is best for lymphatic drainage. Cos I'm broke and cheap!! Clment R, Guay JP, Redpath M, Sauvageau A. Cleveland Clinic. In some cases, they may recommend an alternative treatment to rejuvenate your skin. Antibiotics like penicillin, anticonvulsants including phenytoin and some antidepressants, Switching to lighter weights if your petechiae are due to weightlifting, Antibiotics against bacterial infections such as, Anticancer drugs or radiation therapy to treat leukemia, Corticosteroids to reduce inflammation of the blood vessels, Surgery, either bone marrow transplantation or splenectomy to, Immune-suppressing drugs to treat autoimmune conditions like SLE, Kidney damage from diseases such as Henoch-schnolein purpura and SLE, Bleeding in the brain associated with bleeding disorders such as thrombocytopenia. Petechiae: Pinpoint (1 - 2 mm) red or purple non-blanching spots on the body. Every time you visit a doctor, you should inform them about such medications so that they provide alternatives and prevent recurrence of symptoms. The hemorrhages occur when blood leaks from the tiny capillaries in the eyes, which can rupture . Pulmonary manifestations and glomerulonephritis are common, Necrotizing inflammation of small- to medium-sized vessels, with ANCA, Acral purpura, arthralgias, generalized weakness and fatigue, peripheral neuropathy, glomerulonephritis, Mixed cryoglobulinemia commonly due to chronic hepatitis C infection, Petechiae and purpura that develop within seven to 21 days of medication exposure, Immune complex deposition in small vessels, Petechiae and purpura are common when platelet count is very low, without associated systemic symptoms, Autoimmune condition with antibodies against several platelet surface antigens, Purpura accompanied by arthralgias, abdominal pain, hematuria, and proteinuria; often preceded by an upper respiratory tract infection, Deposition of immune complexes containing immunoglobulin A. Figure 2. The bottle I got was labeled for kids, but I compared it to the exact product for adults, and all the ingredients and amounts were the same. Petechial lesions can occur anywhere on the body irrespective of age, but the children are most affected. Encyclopedia.com. 3. Bilateral doppler of lower extremity negative for clot. Hypocomplementemia is common with cryoglobulinemia, and there is a strong association between cryoglobulinemia and chronic hepatitis C infection. The evaluation of aluminum oxide crystal microdermabrasion for photodamage. Purpuric and petechial rashes in adults and children: initial assessment BMJ 2016; 352 :i1285 doi: Alkhawam, L., & Alam, M. (2009, December). Solar purpura is a skin disorder characterized by areas of purple or red discoloration, found most commonly on the arms, forearms, and legs of elderly people. FastMed's services address a wide spectrum of urgent care, family, and sports medicine needs. . and sudden infant death syndrome (SIDS, or crib death). Latenser BA, Hempstead RW. I don't know how the cancer feels about the boots (like I care!) The kids bottle had a free 33% more in it! I know when I feel like doing that, the fear is winningso I start a new project or divert myself. Microdermabrasion is safe for individuals of all skin types and tones, including those with dark skin. Improvements to the skin following a microdermabrasion session are mild but clinically significant. If the trigger for the petechiae is obvious, for instance, in the case of prolonged straining, complex procedures such as bone marrow biopsy are not necessary. Petechiae are less than 2mm in size (about the size of the tip of a crayon). You may also be required to wear protective eyewear to protect your eyes from irritation. Reporting mother has autoimmune disorder, but unknown what kind. United States Department of Health and Human Services (DHHS), Public Health Service (PHS), Centers for Disease Control (CDC) / Food and Drug Administration (FDA), Vaccine Adverse Event Reporting System (VAERS) 1990 - 06/18/2021, CDC WONDER On-line Database. By bloc, https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/petechial-hemorrhage. Would you like email updates of new search results? The bodys subsequent wound healing forms a new epidermis, effectively removing blemishes, such as scars and blotchy pigmentation, from the skins surface. In recent years, dermatologists and microdermabrasion providers have begun phasing out crystal-based microdermabrasion systems in favor of diamond-tipped handpieces. Get plenty of sleep, don't exercise within 24 hours, and try to not lay on the . Petechiae belong to the larger group of vessel bleeding, the other two . Sunburn. Unauthorized use of these marks is strictly prohibited. When these blood vessels break, blood leaks into your skin. Health A-Z. pentecostal assemblies of the world ordination; how to start a cna school in illinois petechiae after tanning. 2011 Dec;32(4):378-82. doi: 10.1097/PAF.0b013e3181db7ecf. Signs of bleeding may include: Petechiae, which are small, flat red spots under the skin caused by blood leaking from blood vessels Purpura, which is bleeding in your skin that can cause red, purple, or brownish- yellow spots Anyway, after I finished school last month I have a little more time, so a little more room for the fear. The drugs that can cause petechiae include phenytoin, quinine, and penicillin. The reason these lotions are called tingle tanning is that they give a tingling sensation on your skin after you apply the lotion; hence the name. Journal of Travel Medicine 28.4 (2021): taab024. Learn about the symptoms, treatment, and when to worry here. The patient reported that the lesions were mildly painful to palpation, but she was more concerned about the appearance. Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

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