By Lisa Sanders, M.D. | Dec. 29, 2021
“Is there anything else?” asked Dr. Jason Mathis. His patient, a 58-year-old man, had come with his wife to see the young dermatologist at the University of Utah for his annual skin check. Mathis had looked over the handful of moles and skin tags and found nothing alarming. What else was bothering the man?
There was one thing, the patient said after a pause. At the top of his head in the back, the skin seemed to sink into the bone in a few spots. It didn’t hurt; it was just weird. He asked another dermatologist about it a few years earlier. That doctor looked at his head, then checked in a textbook and said it was something or another — he couldn’t remember what the dermatologist called it. But he told the patient not to worry about it, and as far as that doctor was concerned, that was the end of it.
It was weird. Mathis sat down at his computer. He turned to a website he often visited called VisualDx. It was a diagnostic resource, providing thousands of images and cases contributed by doctors from around the world. You could find just about everything here. He often used it to show patients what they had and to reassure them that they weren’t alone. But every now and then he also used it as a reference to learn more about a disease. The brief report on C.V.G. described three forms of the disorder. Primary essential C.V.G. appears with no other symptoms or medical problems. There was also primary nonessential C.V.G.; this was usually associated with intellectual disability, and sometimes psychiatric or ophthalmological problems. Each was seen mostly in men and usually started in adolescence or early adulthood. These were the forms Mathis was familiar with. But this patient had none of the associated comorbidities and had developed the condition later in life.
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