Friday, August 15, 2008

Intermittent rash in an old gentleman


72y, AAM, h/o HTN, BPH and CRF, presents to the office with diffuse, highly pruritic rash that developed over the past couple weeks. He has had intermittent skin rash, similar to this in the past, which has responded to brief course of topical steroids. He denies exposure to any new topical chemicals (soaps, detergents etc) or over the counter medications/ supplements. He also denies recent travel outside Baltimore city. His current medications include a lisinopril, furosemide, doxazosin and amlodipine. On exam, his vital signs are stable. He has diffuse, well-demarcated polygonal plaques with evidence of excoriation and lichenification on upper and lower extremities, as well as the trunk. Biopsy report states that there was evidence of spongiosis, eosinophils and chronic lichenified spongiotic dermatitis in the submitted plaque specimen. PAS stain was negative for fungi

Which of the following is the most likely diagnosis?

A. Lichen Planus- ANSWER
B. Nummular/ Atopic Dermatitis
C. Tinea Corporis
D. Psoriasis
E. Hypersensitivity vasculitis