Reoccurring lesions on arms of HVAC worker

Presenter: Jennifer David, DO, MBA

Dermatology Program: Larkin Community Hospital

Program Director: Stanley Skopit, DO, MSE, FAOCD

Submitted on: October 3, 2014

CHIEF COMPLAINT: Reoccurring growths on forearms

CLINICAL HISTORY: 52 y/o Caucasian male presented to our clinic complaining of reoccurring growths on bilateral forearms that would come and go for the past year. Lesions would begin as small pink papules that would grow over the course of a few weeks, then ulcerate and eventually self resolve. No previous treatments. Of note, the patient works as an HVAC (heating and air conditioning) repairman. When questioned about exposure to caustic materials at work, he did admit to exposure of his forearms to Freon while repairing larger units and frequently scratching his arms while reaching beneath the units.

PHYSICAL EXAM:
Left forearm- 4cm pink vegetative plaque with central ulceration and crusting on a background of numerous excoriations

Right forearm- 1cm crusted ulceration on a background of scattered excoriations and pink papules

Negative for cervical and axillary lymphadenopathy

LABORATORY TESTS:

Tissue cultures were negative for acid-fast mycobacteria and fungal/yeast elements however did grow heavy amounts of staphylococcus aureus.

DERMATOHISTOPATHOLOGY:

Skin biopsy was performed, and the histopathology showed pseudoepitheliomatous hyperplasia with sinus tract formation, focal suppurative inflammation, and focal granuloma formation with gram-positive cocci within the pseudoepitheliomatous hyperplasia.