Itchy, Dark Rash on Upper Back

Presenter: Suzanne Sirota Rozenberg, D.O.,Scott Goffin, D.O., Darren DiGulio, D.O., Yelva Lynfield, M.D., Marvin Watsky, D.O.
Dermatology Program: St. John’s Episcopal Hospital, Far Rockaway, New York
Program Director: Marvin Watsky, D.O.
Submitted on: May 30, 2003

CHIEF COMPLAINT:  complains of itchy, dark rash on upper back for 5 years

CLINICAL HISTORY:

Signs and symptoms:

Previous Treatment:  Patient states that he was treated in Yemen with unknown topical medications. He states that he had some resolution, but then had recurrences.

Other information:  Patient states that he has no prior history of trauma or previous biopsy. Pt. Has no significant past medical history or surgical history, no known allergies and no medications at this time.

PHYSICAL EXAM:

Physical Examination large, hyperpigmented , triangular ,slightly raised patch from the spine to the left posterior axillary line in the T2-T4 dermatome.

 

 

LABORATORY TESTS:

UA WNL
CBC WNL
SMA7 WNL

Thoracic spine x-ray-no definitive evidence of compression fracture, spondylolisthesis or disc narrowing

DERMATOHISTOPATHOLOGY:

Microscopic description: Punch biopsy: skin w/mild hyperkeratosis and minimal acanthosis, dermal melanophages and hemociderin deposits in the upper dermis where proliferastion of small vessels is quite prominent.

Congo red stain neg.

DIFFERENTIAL DIAGNOSIS:

1.   Macular Amyloidosis
2.   Notalgia Parasthetica
3.   Herpes Zoster
4.   Lichen Simplex Chronicus
5.   Becker’s Nevus


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