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


August 25, 2020

Physical Examination and Workup

A full examination of the skin is notable for multiple reddish-brown, scaling patches and thin plaques. Some coalesce into annular or polycyclic configurations and are diffusely scattered throughout the trunk, buttocks, posterior axillary folds, and bilateral upper and lower extremities (Figure 1).

Figure 1.

Some patches have a wrinkled surface that resembles "cigarette paper." Interspersed throughout are areas of resolving hyperpigmentation. In total, about 30%-40% of his body surface area is involved. No lymphadenopathy or organomegaly is noted upon palpation, and the remainder of the physical examination results are unremarkable.

A broad shave biopsy is performed, and the results are shown in Figures 2 and 3. A lymphocytic infiltrate is concentrated at the dermoepidermal junction. It extends into the epidermis, which has minimal overlying spongiosis (Figure 2). Cluster of differentiation (CD) 3 staining reveals numerous T lymphocytes within the epidermis and aligned along the dermoepidermal junction (Figure 3).

Figure 2.

Figure 3.


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