Lady with itchy bumps

57 yr old Caucasian lady with past history of depression and HTN presented with gradually worsening rash and itching for 4 days which started first on her both arms and later over her legs. She has been scratching and developed some healed ulcers over her arms and legs but denies any pain associated with it. She also denies any associated fever, cough, nausea, vomiting or diarrhea. She has been on Effexor XR 150 q daily and Lisinopril 20 mg q daily for last 1½ yr with out any problem. She denies smoking nicotine, drinking ETOH or using illicit drugs. She is a homemaker and lives with her husband. 2 weeks ago she returned from her travel with her husband from Nashville and Indiana. She went from Nashville to Indiana in a riverboat and stayed in hotels. She does not have pets at home and states that she usually takes hot showers. On exam she has several sub-centimeter papular eruptions, a few of them excoriated with surrounding cellulitis on upper and lower extremities, shoulder and back.

What is the most likely diagnosis?
1. Allergic contact dermatitis
2. Infectious folliculitis
3. Papular urticaria- ANSWER
4. Furuncular Myriasis
5. Cutaneous Necrosis

Young man with a rash on shoulder

A young man in his 30’s, with no significant PMH, comes to the office after noticing a pruritic rash on the Lt shoulder and pain in the Lt axilla that started after working in his father’s basement yesterday. The symptoms started late in the evening and worsened over the past 12- 24 hrs. He denies fever, chills, nausea or vomiting. He thinks that he might have been bitten by an insect, but cannot say for sure. He also spent some time working in the back yard, a day earlier. He is not sure if he came in contact with chemicals while working in the basement. On exam, his vital signs are stable. He has a 5- 6 cm well demarcated, erythematous macular rash on the Lt shoulder with a linear extension to the Lt axilla. A solitary, tender, mobile lymph node is appreciated on the anterior axillary fold. What is the most likely diagnosis?

1. Ringworm infection
2. Cellulitis and secondary lymphangitis from an insect bite- ANSWER.
3. Contact dermatitis
4. Folliculitis
5. Erythema migrans