akele7 Posted July 17, 2011 Share Posted July 17, 2011 I cannot figure this out for the life of me.. My patient is a 27 year old female. Has a rash on her left forearm, left thigh and medial and later parts of her heels. It's red, papular shaped, and does not itch. She is not using any Antibiotics. She was using a new soap, but has stopped, and the rash is still appearing in new spots now up her left arm and near her left knee (See attached pictures). No ticks were found, and she is not sexually active. Diagnosis? Thoughts? She has tried triamcinolone with some results. Link to comment Share on other sites More sharing options...
flyingsquirrel Posted July 17, 2011 Share Posted July 17, 2011 is is spreading to the plams and soles? any change with antihistamines? what time of year did it first appear? Link to comment Share on other sites More sharing options...
flyingsquirrel Posted July 17, 2011 Share Posted July 17, 2011 is is spreading to the plams and soles? any change with antihistamines? what time of year did it first appear? Link to comment Share on other sites More sharing options...
akele7 Posted July 17, 2011 Author Share Posted July 17, 2011 is is spreading to the plams and soles?any change with antihistamines? what time of year did it first appear? It's not spreading to the palms or the soles. It is just on the lateral and medial parts of the heels. She hasn't tried any antihistamines. It first appeared 4th of july weekend. She had not gone swimming in any oceans/lakes that weekend or prior to the rash. She is on no meds, and NKA. Link to comment Share on other sites More sharing options...
akele7 Posted July 17, 2011 Author Share Posted July 17, 2011 is is spreading to the plams and soles?any change with antihistamines? what time of year did it first appear? It's not spreading to the palms or the soles. It is just on the lateral and medial parts of the heels. She hasn't tried any antihistamines. It first appeared 4th of july weekend. She had not gone swimming in any oceans/lakes that weekend or prior to the rash. She is on no meds, and NKA. Link to comment Share on other sites More sharing options...
flyingsquirrel Posted July 17, 2011 Share Posted July 17, 2011 It could be poison ivy or related toxic exposure, but it's not a great story. It looks kind of like the begining of dyshidrotic eczema, but without spread to the palms and/or soles that isn't a great fit either. If it was dyshidrotic eczema it might respond to oral/otc antihistamines and definately should respond to a more potent topical corticosteriod (ie clobetasol). Those are my only real thoughts...derm is NOT something I have much experience with. I can tell you with a great deal of confidence that it's not sepsis or small/chicken/monkeypox. Link to comment Share on other sites More sharing options...
flyingsquirrel Posted July 17, 2011 Share Posted July 17, 2011 It could be poison ivy or related toxic exposure, but it's not a great story. It looks kind of like the begining of dyshidrotic eczema, but without spread to the palms and/or soles that isn't a great fit either. If it was dyshidrotic eczema it might respond to oral/otc antihistamines and definately should respond to a more potent topical corticosteriod (ie clobetasol). Those are my only real thoughts...derm is NOT something I have much experience with. I can tell you with a great deal of confidence that it's not sepsis or small/chicken/monkeypox. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 17, 2011 Moderator Share Posted July 17, 2011 my derm knowledge... if it is wet ----dry it if it is dry --- wet it try a little lotrisone if any fungal possible beyond that... ????? Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 17, 2011 Moderator Share Posted July 17, 2011 my derm knowledge... if it is wet ----dry it if it is dry --- wet it try a little lotrisone if any fungal possible beyond that... ????? Link to comment Share on other sites More sharing options...
JFarnsworth Posted July 17, 2011 Share Posted July 17, 2011 Did you do a KOH or biopsy it? That's what I would have done. Link to comment Share on other sites More sharing options...
JFarnsworth Posted July 17, 2011 Share Posted July 17, 2011 Did you do a KOH or biopsy it? That's what I would have done. Link to comment Share on other sites More sharing options...
akele7 Posted July 23, 2011 Author Share Posted July 23, 2011 The only dx we are thinking is a possible atypical pityriasis roasea..Everyone is kinda scratching their head. new picture of the rash on the thigh.. Link to comment Share on other sites More sharing options...
akele7 Posted July 23, 2011 Author Share Posted July 23, 2011 The only dx we are thinking is a possible atypical pityriasis roasea..Everyone is kinda scratching their head. new picture of the rash on the thigh.. Link to comment Share on other sites More sharing options...
DizzyJ Posted July 25, 2011 Share Posted July 25, 2011 my derm knowledge... if it is wet ----dry it if it is dry --- wet it try a little lotrisone if any fungal possible beyond that... ????? Don't forget.....If you don't want it, don't touch it! Link to comment Share on other sites More sharing options...
DizzyJ Posted July 25, 2011 Share Posted July 25, 2011 my derm knowledge... if it is wet ----dry it if it is dry --- wet it try a little lotrisone if any fungal possible beyond that... ????? Don't forget.....If you don't want it, don't touch it! Link to comment Share on other sites More sharing options...
Klgoodma Posted October 16, 2011 Share Posted October 16, 2011 almost looks like follicular eczema...but it doesn't itch, you say? Also resembles possible contact derm, but again, without itching story is unlikely. Your best bet is to treat with a strong steroid cream like temovate and see if it improves. Link to comment Share on other sites More sharing options...
Klgoodma Posted October 16, 2011 Share Posted October 16, 2011 almost looks like follicular eczema...but it doesn't itch, you say? Also resembles possible contact derm, but again, without itching story is unlikely. Your best bet is to treat with a strong steroid cream like temovate and see if it improves. Link to comment Share on other sites More sharing options...
FriarMedic Posted September 5, 2012 Share Posted September 5, 2012 Was granuloma annulare on your differential? what was it? Link to comment Share on other sites More sharing options...
Guest JMPA Posted September 6, 2012 Share Posted September 6, 2012 Looks like insect bites, i would have mesquito and bed bug on my differential. Family/household members have it? only on exposed body surface? looks like insect bites Link to comment Share on other sites More sharing options...
Joelseff Posted September 6, 2012 Share Posted September 6, 2012 My guess is contact dermatitis. Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
akele7 Posted October 5, 2012 Author Share Posted October 5, 2012 Sorry for the delay, as for the people wondering...it was dx as atypical PR. The patient was given a dose of kenalog, and she cleared up a week after....this was after having the rash for 6 weeks. Contact dermatitis was r/o due to no itching as well with bed bugs. Link to comment Share on other sites More sharing options...
pafguy77 Posted October 8, 2012 Share Posted October 8, 2012 Actually knew someone who suffered from over 100 bites on their feet and legs while I was in S.E. Asia. Looked quite uncomfortable and painful but they managed after a week of med's and lots of rest. By the way, good work "akele7". Link to comment Share on other sites More sharing options...
rcdavis Posted October 8, 2012 Share Posted October 8, 2012 Atypical pityriasis rosea? Sure doesn't look like it.. Wrong distribution, wrong rash characteristics: seems papular and not at all papulosquamous. Wrong season. And, as far as I know, steroids do little if anything to pr. What were your diagnostic criterion for making the dx? Aprill11 or Banuchi? What do you think? Link to comment Share on other sites More sharing options...
primadonna22274 Posted October 8, 2012 Share Posted October 8, 2012 I agree. Nothing about that rash except for the chronology reminds me of PR. I would doubt any dx that wasn't based on derm path/full thickness punch bx. Link to comment Share on other sites More sharing options...
pafguy77 Posted October 15, 2012 Share Posted October 15, 2012 This is somewhat related to this thread so thought I would ask. What's the best way to get rid of scars? Vit E or Aloe plant? Thanks. Link to comment Share on other sites More sharing options...
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