Tuesday, August 16, 2011

Derm Photo Quiz: An Interesting Rash

This case involves a 67 year old, diabetic man who has taken no medications for the last 4 years except for a daily aspirin. He presented to my clinic for the first time in over four years with a 2 week history of a rash that started on his right arm as seen below. His left arm had a similar appearance.
The rash then spread to the rest of the right arm and all extremities. The rash was initially pruritic but by the time of the visit the itching had resolved. He denied any recent OTC medication use except for the daily aspirin. He denied any new or unusual foods or contacts. He was feeling well. He denied fever, nausea, vomiting, diarrhea, abdominal pain or headache. He denied any recent tick bites or possible exposure to ticks. His trunk showed no lesions but his legs were affected as seen below.

Lab work revealed: glucose 281, creatinine 0.9, sodium 134, total bilirubin 1.50, direct bilirubin 0.30 (both slightly elevated), AST 42, ALT 72, CRP 0.2, WBC 4,800 a with normal differential, platlets 92,000. He was seen by a dermatologist that day, and given a provisional diagnosis. A biopsy was done which confirmed the diagnosis. What was the diagnosis?

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posted by Clay @ 8/16/2011 09:43:00 AM   7 comments


At 6:07 AM, Blogger joe said...


At 4:33 PM, Blogger Clay said...


At 8:22 PM, Blogger joe said...

fixed drug reaction, ASA.

At 10:24 PM, Blogger Clay said...

Inverse Pityriasis Rosea was the diagnosis given to this man by the dermatologist. The pathologist gave a report which in summary stated that the findings were compatible with pityriasis rosea. The patient came back to see me several days later. He was still feeling well and his lesions were beginning to fade.

At 10:34 AM, Blogger joe said...

Very interesting! I have never seen or been aware of Inverse Pityriasis Rosea or Gigantean lesions. Good work!

At 11:59 AM, Anonymous Anonymous said...

I have a very similar rash as this, had 4 biopsys, with no results, tried every cream on the market, self injections of new drugs, with no relief. My dermotologist refuses to even test me for this, said it was not it, but, damn, it looks so much like it..... She tells me I am a puzzle, and has no idea what it is. She sent me to her teacher, who says it in not psoriassis, but? Have recently been diagnosed as diabetic, started meds yesterday, but am so tired of this rash. I need help, in getting someone to listen, in getting treatment. I went thru chemo, breast cancer survivor, and now this. If they don't know what it is, why should I learn to live with it, it could be treatable.

At 12:07 PM, Anonymous Anonymous said...

I had Pityriasis Rosea. The only treatment they knew that was somewhat effective, was UV thereapy, (they told me no cream or medication would help). UV therapy did slow down the spreading of it. But the rash still lasted a good 8 weeks


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