Presenter: Brittany Grady, DO; Kevin Miller, DO; Charles Elias, DO; Shannon Wiedersum, DO; John Hassani, DO; Nicole Ruth, DO

Dermatology Program: Hackensack Meridian Health Palisades Medical Center

CHIEF COMPLAINT:  long-standing pruritic rash involving his back, hands, and feet

CLINICAL HISTORY: A 92-year-old Caucasian, male, long-term care patient presents with a complaint of a long-standing pruritic rash involving his back, hands, and feet.  The nursing staff reported the rash to be present for the past year while he had been a long-term resident in their care. The rash began on the hands and had slowly spread to involve his trunk and lower extremities. The patient reported mild, but tolerable, pruritus associated with the rash. The patient denied fevers, chills, headaches, abdominal pain, shortness of breath, or recent weight changes. The patient had been prescribed several mid- to high-potency topical corticosteroids as well as several topical antifungal creams over the past year by his primary care provider. Currently, the patient was using betamethasone/clotrimazole cream twice daily as well as urea cream daily with no improvement in his condition. The patient had been living in this long-term care facility for one year prior to our dermatology consultation. The patient denied recent travel or a history of household contacts with a similar rash prior to his admission to long-term care. The patient had a past medical history that included: dementia, cardiovascular disease, chronic kidney disease, hypertension, and osteoporosis.