Presenter: Peter A. Vitulli, Jr. D.O., Steven Moreno, D.O., Eric Adelman, D.O.
Dermatology Program: Nova Southeastern University / North Broward Hospital District, Ft. Lauderdale, FL
Program Director: Stanley Skopit, D.O.
Submitted on: June 29, 2002
CHIEF COMPLAINT: Pruritic Rash With Alopecia
CLINICAL HISTORY: A 78-year-old African American male presents to the dermatology clinic with a nine-year history of a progressively expanding, mildly pruritic rash on his neck and face. He reports that the eruption initially started on his neck and has since spread to involve his face. Additionally, he is experiencing progressive hair loss and a chronic cough, but he has not sought medical attention for these symptoms until now. His past medical history includes hypertension, and he has no significant past surgical history. He is allergic to penicillin. Family history is non-contributory, and socially, he lives with his wife and has two sons. He denies any use of tobacco or illicit drugs. In terms of previous treatment, he has not received any interventions for his skin condition. He is currently taking Adalat 30 mg daily for his hypertension.
PHYSICAL EXAM:
Examination reveals mildly erythematous scarring alopecia extending from the front of the scalp to the occiput, sparing the temperoparietal areas. The forehead, bilateral cheeks, jawline, and neck reveal multiple discrete, annular rings of grouped, firm papules with central atrophy. There are no other suspicious lesions noted on the rest of his body.
LABORATORY TESTS:
All labs within normal limits except for an elevated ACE level of 92 IU/L.
CXR reveals bilateral hilar adenopathy
DERMATOHISTOPATHOLOGY:
Microscopic description: Biopsy of scalp: Superficial and deep granulomatous perifolliculitis.
Special stains negative for microorganisms.
Biopsy of Left Neck: Noncaseating granulomatous dermatitis.
Special stains negative for microorganisms.
DIFFERENTIAL DIAGNOSIS:
1. Granulomatous Secondary Syphillis
2. Granulomatous Rosacea
3. Sarcoidosis
4. Tuberculoid Leprosy
