mea505 Posted October 6, 2011 Share Posted October 6, 2011 Dear all, Recently, I posted a message that included a photo of a rash, but the photo was a little out of focus, which made the photo difficult to view. One person did respond to my inquiry, but he or she was not able to assist me with the rash because of the focus problem. The problem with the focusing of the rash has been rectified, but I am finding it difficult to post a photo on this forum because of the size of the image. Therefore, I re-cropped the image again. This rash has been present for about 40 days or so. The medical history includes hypertension, depression, chronic back pain and anxiety. It is certainly not a rash that is involved with anything consumed, as it is very localized on the upper region of the back. The patient is 53 years of age, with no other pertinent medical history. The rash itches at times, quite extremely; but nothing (as of yet) has been used for the rash. Because of the extreme restrictions with regard to the sizes of the images that one can upload onto this forum, I did the best I could do with respect to the image. I am hoping that someone can and will chime in for me. I would really appreciate it if a Dermatology PA would chime in and let me know his or her thoughts about this rash. The photo is attached to this message. Thanks in advance, Link to comment Share on other sites More sharing options...
aprillh Posted October 6, 2011 Share Posted October 6, 2011 Derm is a visual field and with the photo being so blurry, we derm PAs are pretty handicapped. That being said, can you describe the lesions? Do they have scale? In the photo, they appear salmon-colored. Is this accurate? What, if any, treatments have been tried? Has anything helped? Is there anything that makes it worse? Was there a precipitating event before this occured? These things may help with the dx. Link to comment Share on other sites More sharing options...
mea505 Posted October 6, 2011 Author Share Posted October 6, 2011 Yes, I understand the problem with the blurriness, but because of the size restrictions when posting an image on this forum, I was forced to crop the photo three times in order to get it small enough to that the forum program would accept the image. As far as the description is concerned, the rash is not scaling at all, and it is salmon-colored. No treatment has been tried as of yet, only because an accurate diagnosis has not been available to me. There have been no precipitating events prior to the rash development, no change in any habits or change in diets, etc. There did seem to be a herald patch at first, and one of my colleagues has suggested that it might just be Pityriasis rosea, but this has not been confirmed. They itch at times, very profusely. Then, there are times when the rash does not aggravate anything. Does this information, along with the only image that I was successful in uploading help? I hate it that there is such a restriction on the size of the images that one can actually upload onto the system. It only allows for a specific (kb) size. I would certainly appreciate any further inputs. I do understand that dermatology is a visual science, and I wish that I had a better image that I can upload without any problems. Mark Link to comment Share on other sites More sharing options...
jennbrat Posted October 7, 2011 Share Posted October 7, 2011 PR was the first thing I thought of but I am going with a blurry picture. Link to comment Share on other sites More sharing options...
aprillh Posted October 7, 2011 Share Posted October 7, 2011 Well it could be atypical PR. I had a case recently that threw me because it was definitely not in the Christmas tree pattern and it was isolated to lower extremities yet the lesions looked like typical PR. I'm concerned with the lack of scale however. If you look very closely, there should be a collarette of scale near the periphery of the lesions. Also, are you sure the patient hasn't treated it with anything? I wonder about tinea incognito too. Anyway, in derm our motto is when in doubt, biopsy. Link to comment Share on other sites More sharing options...
JFarnsworth Posted October 9, 2011 Share Posted October 9, 2011 Give this person a steroid cream and see what happens. The if it doesn't help, get a biopsy. I'm thinking atopic dermatitis as tinea usually doesn't occur in the upper back only. Also, I can't really see the rash, as you know. Link to comment Share on other sites More sharing options...
mea505 Posted October 9, 2011 Author Share Posted October 9, 2011 Yes, I understand that you cannot view the image well; this is due to the extreme restrictions with respect to the size of the image allowed through this forum. Don't know why they have such a harsh restriction. I am a retired PA, and the rash you see in the "blurry" image is on my back, which is why I presented it to the forum. It's been quite a while since I'v practiced and I merely wanted some assistance. I suggested that we share personal e-mail addresses and then I can e-mail you a much better view of the rash, so to increase the probability of making a more definitive diagnosis. Let me know. If you would not mind doing this, my e-mail address is mea505@cox.net. I will really appreciate it. TIA, Link to comment Share on other sites More sharing options...
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