Presenter: Stephen Colden Cahill, DO, Stephanie Juliet Kang, DO
Dermatology Program: Tri-county Dermatology, Ohio
Program Director: Schield Wikas, DO, FAOCD
Submitted on: November 5, 2015
CHIEF COMPLAINT: Rash on the body
CLINICAL HISTORY: In August, a 37-year-old Caucasian female (Fitzpatrick skin type 2) with a past medical history of depression, DJD, and spinal stenosis, presented for consultation regarding a five year pruritic rash over her face, neck, chest, shoulders, and arms. She was seen one month ago by her primary care physician, who performed lab work which showed an elevated CRP 31.3 (normal 0-5mG/L), normal CBC w/diff and negative ANA. She was placed on a 7 day prednisone taper and OTC loratidine. Her symptoms had mild short term relief and then promptly returned. She reports suffering from similar lesions over the last five years which have waxed and waned in intensity. She denies any new recent medications or herbal supplement additions. She cannot specifically associate the lesions with sun exposure. She denies any systemic symptoms, other than low back pain which has been an ongoing issue for several years. She is an active one pack per day smoker and occasional social drinker, denies any illicit or recreational drug use.
PHYSICAL EXAM:
Multiple scattered 0.5-1cm erythematous, non-scaly papules with occasional coalescing into annular plaques. The lesions are located in a photo distributed pattern over face, neck, shoulders, upper back, and arms.
LABORATORY TESTS:
RPR- non-reactive
Histone antibodies <1 ss<1 ss<1 sm antibody<1 sm rnp/<1 dna ab<4 crp 3
DERMATOHISTOPATHOLOGY:
A punch biopsy was performed.
DIFFERENTIAL DIAGNOSIS:
1. Systemic Lupus erythematosus
2. Tumid lupus erythematosus
3. gyrate erythema
4. reticular erythematosus mucinosis
5. Polymorphous light eruption
