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For more than 70 years methotrexate has been a popular tool in the prescription toolkit of doctors around the world. However, a recent case report by a team from the United Kingdom showed how important it is for prescribing doctors to also keep a close eye on some of the well-known adverse events associated with the medication.

This newborn infant was noted to have a congenital skin malformation on both sides of his face. However, the pregnancy was uncomplicated, he is feeding well, and no other abnormalities were seen on examination.

A 36-year-old pregnant woman at 27 weeks gestation presented to the obstetrical triage for evaluation of possible abscess due to a lesion on her buttock that first appeared 1 week ago. Since that time, it has become increasingly painful and itchy. Although she denies any systemic symptoms, her pregnancy is complicated by gestational diabetes and obesity. However, she is HIV negative and her other prenatal labs were unremarkable.

A 57-year-old man presented to clinic with this persistent skin lesion on his thumb. Three months ago, he lanced the lesion, producing some purulence and blood. Since then, it has bled almost daily and has not healed. He was treated with silver nitrate by another clinician after one month, but the lesion persists. His past medical history is significant for diabetes and his family history is significant for 2 cousins with melanoma.

A 59-year-old man presented to clinic with concerns that his ezetimibe prescription was causing an itchy rash. The rash first appeared on his hand 1 year ago and now it involves his arm, as well. The man's past medical history is significant for coronary artery disease, hypertension, hyperlipidemia, and hypothyroidism. He has tried a topical antifungal agent and oral fluconazole to no avail.

A 59-year-old woman presented to clinic for evaluation of multiple moles. Although the moles were not suspicious on physical exam, she was noted to have bilateral deformities of her thumb nails. Her past medical history is significant for chronic knee pain and breast cancer that was successfully treated 13 years ago. What is your diagnosis?