Non pruritic erythematous patch

Presenter: Amy D Adams, DO – PGY3
Dermatology Program: Midwestern University / Arizona Desert Dermatology – Kingman, AZ
Program Director: Don Anderson, DO
Submitted on: Jan 25, 2010

CHIEF COMPLAINT:  “Eczema spot that won’t go away”

CLINICAL HISTORY:

Signs and symptoms:  Non pruritic erythematous patch on the patients right buttock that has been present for at least four years and was previously diagnosed and treated as Eczema. Reports minimal change over the last four years with no period of clearance.

Previous Treatment:  Topical antifungal creams, Class I-VI topical corticosteroids and an intramuscular Triamcinolone injection. Pt reports slight benefit from the topical combination of Nystatin / Triamcinolone but denies any benefit from the other medications.

Other information:  Pt works in a day care center. She is not taking oral prescription medications or herbal supplements.

PHYSICAL EXAM:

A 62 year old Caucasian female with a 35 x 60mm patch of erythema on her right superior buttock. The lesion is non-tender and surrounding erythema blanches with diascopy. No palpable lymph nodes are present.

 

 

 

 

 

LABORATORY TESTS:

CBC with peripheral smear: Within Normal Limits
Complete Metabolic Panel: Within Normal Limits

DERMATOHISTOPATHOLOGY:

See Photos Below

 

 

 

 

DIFFERENTIAL DIAGNOSIS:

1.   Eczema
2.   Psoriasis
3.   Candidiasis
4.   Mycosis Fungoides
5.   Majocci Granuloma


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