Progressive Worsening Rash

Presenter: Marya Cassandra, Greg Houck, Valerie Johnson, Kristin Witfill, Andrea Nelson, and Nanda Channaiah
Dermatology Program: Nova Southeastern University/Sun Coast Hospital
Program Director: Rick Miller, DO, FAOCD
Submitted on: Apr 28, 2006

CHIEF COMPLAINT:  1.5 year history of a progressively worsening rash on the face, trunk, and upper and lower extremities, including the palms and soles. This was previously diagnosed as vitiligo and eczema.

CLINICAL HISTORY:

Signs and symptoms:  Lesions were very pruritic and scaly in nature

Previous Treatment:  Claritin, Atarax, Protopic, salicylic acid and various topical steroids

Other information:  No family history of a similar rash. No recent travels.

PHYSICAL EXAM:

On physical examination, thickening and furrowing of the scalp and facial skin was apparent, as was alopecia of the frontal and vertex scalp. The facial changes were consistent with leonine faces. Diffuse hyperkeratotic papules, plaques, and nodules with multiple areas of depigmentation and secondary impetiginization was also present. The palms and soles revealed extensive hyperkeratosis. All nails displayed onycholysis and subungual hyperkeratosis.

 

 

 

LABORATORY TESTS:

The CBC and CMP were WNL. ANA was found to be negative and RPR was non-reactive.

DERMATOHISTOPATHOLOGY:

Biopsy from the right preauricular area demonstrates an atypical lymphoid infiltrate consisting of numerous large cells with diffuse CD30+ staining.

 

 

 

 

DIFFERENTIAL DIAGNOSIS:

1.   Leishmaniasis
2.   Leprosy
3.   Chronic actinic dermatitis
4.   Mycosis fungoides
5.   Pityriasis rubra pilaris


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