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BACKGROUND
A 59-year-old man presents to the emergency department complaining of a diffuse, painful rash. The rash first arose 3 months ago and resolved after a course of oral prednisone. However, the rash recurred a month ago, manifesting in its current state and affecting most of the surface of his upper and lower extremities. No new drugs were added when the initial rash started, and he received only tapered prednisone therapy before his most recent presentation. At that time, he began applying an antibiotic ointment (Neosporin) on affected areas, with subsequent worsening of his rash. A short course of fluocinonide cream resulted in mild improvement. He is now taking only hydroxyzine for symptomatic relief of severe pruritus. He denies having other complaints.
The patient's medical history is significant for allergic contact dermatitis and hypertension. On physical examination, fissuring is present on the creases of his palms and heels, and his nails are thin. An erythematous, macular, scaly rash is observed on the patient's forearms and on the lateral aspects of both thighs, with multiple excoriations and pale, superficial ulcerations. His vital signs and the rest of the physical findings are unremarkable. A KOH preparation of a sample obtained from a thigh lesion yielded negative results.
What is the diagnosis?
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Hint
The patient continued using neomycin despite worsening of the rash.
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Authors:
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Anusuya Mokashi,
Medical Student,
New York Medical College, Valhalla
Lynne H. Morrison, MD,
Associate Professor,
Department of Dermatology,
Oregon Health and Science University (OHSU) Department of Dermatology
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eMedicine
Editor:
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Erik D. Schraga, MD,
Department of Emergency Medicine,
Kaiser Permanente,
Santa Clara Medical Center, Calif
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