Presenter: Leah M Schammel, DO; Jean Holland, MD

Dermatology Program: Oakwood Southshore

Program Director: Dr. Steven Grekin

Submitted on: July 7, 2011

CHIEF COMPLAINT:  Cyclical cutaneous eruption that recurred each month with her menstrual cycle

CLINICAL HISTORY: A 47-year-old Caucasian female presented with a chief complaint of a cyclical cutaneous eruption that recurred each month with her menstrual cycle. The eruption began in March of 2004 after the patient discontinued oral birth control pills. She stated the cutaneous eruption was extremely pruritic and occurred a few days before each menstrual cycle. The eruption consisted of “red bumps” and “raised red scaly areas” on her forearms, abdomen, and upper thighs.

PHYSICAL EXAM:
Physical examination revealed a well-appearing middle-aged adult female with multiple excoriated red papules and pustules coalescing into plaques on the dorsal forearms, upper thighs, and abdomen. No lymphadenopathy or mucosal lesions were found.

LABORATORY TESTS:

Complete blood count with differential, complete metabolic panel, lipid panel, and hepatitis panel revealed a slight elevation in cholesterol.

In April 2007, a bone marrow biopsy was performed that was negative.  A CT of the chest, abdomen, and pelvis was also performed that revealed cysts on her ovaries.

DERMATOHISTOPATHOLOGY:

Multiple biopsies were performed between March 2004 and March 2008. Most of the biopsies revealed psoriasiform hyperplasia, spongiosis, and parakeratosis. A superficial and mid perivascular infiltrate consisting of lymphocytes, eosinophils, and histocytes were seen in the dermis. The infiltrate was PAS and CD30 negative.

DIFFERENTIAL DIAGNOSIS:

1.   Erythema Multiforme
2.   Dermatitis Herpetiformis
3.   Drug Eruption
4.   Acute Generalized Exanthematous Pustulosis
5.   Pustular Psoriasis