Unremitting rash on the feet

Presenter: Robert Levine, DO, Tara Whelan, DO, Suzanne Sirota-Rozenberg, DO, FAOCD
Dermatology Program: St John’s Episcopal Hospital, Far Rockaway, NY
Program Director: Marvin Watsky, DO, FAOCD
Submitted on: Aug 12, 2011

CHIEF COMPLAINT:  “Rash on the feet”

CLINICAL HISTORY:

Signs and symptoms:  A 71-year-old male presented for follow up in a busy dermatology practice. He was being treated for about 6 weeks for suspected psoriasis with minimal improvement. He had mild pruritis and the rash seemed to be spreading.

 

Previous Treatment:  topical steroids (mid-high potency), topical calcipotriene, topical antifungals (by prior physician)

Other information:  He had no other contributing skin lesions. He is of Jewish Ashkenazi descent.

PHYSICAL EXAM:

 

 

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Superficial and deep dermal proliferation of small, angulated vessels lined by inconspicuous endothelial cells, suggestive of lymphatics. These ‘jagged’ vessels separate collagen bundles and are accompanied by a sparse infiltrate of lymphocytes and plasma cells.

DIFFERENTIAL DIAGNOSIS:

1.   Angiosarcoma
2.   Microvascular Hemangioma
3.   Hobnail Hemangioma
4.   Kaposiform Hemangioendothelioma
5.   Spindle Cell Hemangioma


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