Presenter: Amy D Adams, DO – PGY3
Dermatology Program: Midwestern University / Arizona Desert Dermatology – Kingman, AZ
Program Director: Don Anderson, DO
Submitted on: January 25, 2010
CHIEF COMPLAINT: “Eczema spot that won’t go away”
CLINICAL HISTORY: 62 year old Caucasian female presented with nonpruritic erythematous patch on the patient’s right buttock that has been present for at least four years and was previously diagnosed and treated as Eczema. Reports minimal change over the last four years with no period of clearance. Previously has tried Topical antifungal creams, Class I-VI topical corticosteroids, and an intramuscular Triamcinolone injection. Pt reports slight benefit from the topical combination of Nystatin / Triamcinolone but denies any benefit from the other medications. Pt works in a daycare center. She is not taking oral prescription medications or herbal supplements.
PHYSICAL EXAM:
A 35 x 60mm patch of erythema on her right superior buttock. The lesion is non-tender and surrounding erythema blanches with diascopy. No palpable lymph nodes are present.
LABORATORY TESTS:
CBC with peripheral smear: Within Normal Limits
Complete Metabolic Panel: Within Normal Limits
DERMATOHISTOPATHOLOGY:
DIFFERENTIAL DIAGNOSIS:
1. Eczema
2. Psoriasis
3. Candidiasis
4. Mycosis Fungoides
5. Majocci Granuloma
