A Man With a Rash on Nearly Half of His Body for 8 Years

Richard Harold Flowers IV, MD; Stephany Lynn Vittitow, BA; Corina Rusu, MD, PGYIII

Disclosures

August 25, 2020

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

An 80-year-old man with a history of diverticulosis, osteoarthritis, and hypertension presents to a general dermatology clinic with a gradually worsening diffuse rash (Figure 1).

Figure 1.

The occasionally pruritic rash has been present on his face, trunk, and upper and lower extremities for approximately 8 years. He had previously applied hydrocortisone 2.5% ointment to his face and betamethasone 0.05% cream to his extremities without significant effect.

The patient has no personal or family history of skin disease. He reports no recent medication changes and takes only hydrochlorothiazide for hypertension and naproxen occasionally for his osteoarthritis. Over the past few months, he has had a weight loss of 4-5 pounds. No lymphadenopathy is noted. The results of the remainder of his review of systems are normal.

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