Dermatology Case Challenge: An Accountant on a Weight-Loss Program Has a Rash, Poor Sleep

Melba Estrella, MD; John Plante; Andraia Li; Margaret LaPorte; Dirk M. Elston, MD


January 24, 2023

Physical Examination and Workup

Upon physical examination, the patient is a well-appearing middle-aged man with an obese physique. His vital signs include a temperature of 98.3°F (36.8°C), blood pressure of 142/83 mm Hg, a respiratory rate of 15 breaths/min, and a heart rate of 87 beats/min.

He has mild conjunctival injection bilaterally. His nasal mucosa is pale with clear rhinorrhea. He has a regular heart rhythm with no murmurs or gallops. His respirations are nonlabored, and his breath sounds are clear to auscultation bilaterally. Upon abdominal examination, truncal obesity is observed. His abdomen is soft and nontender with normal bowel sounds. Neurologic examination findings are normal.

Skin examination reveals multiple erythematous papules that coalesce, forming poorly demarcated plaques confined to friction areas on the posterior border of both axillary folds, with sparing of axillary vaults. Few excoriations with overlying sanguineous crusting are present. Lips, oral mucosa, and nails are unaffected.


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