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JAMA Clinical Challenge
March 17, 2015

Diffuse Vesicular Rash With Intractable Pruritus

Author Affiliations
  • 1Department of Dermatology, Mayo Clinic, Rochester, Minnesota
JAMA. 2015;313(11):1158-1159. doi:10.1001/jama.2014.17575

An 82-year-old man presented with intractable pruritus of several months’ duration and a skin eruption. He reported being diagnosed with dermatitis herpetiformis more than 20 years ago and receiving sulfapyridine and dapsone for treatment. He stopped taking these medications because of limited benefit and concern about nephrotoxicity. Since then, he was treated with periodic courses of oral antibiotics and oral corticosteroids. Recently, extensive skin disease and pruritus developed. He noted 20 years of chronic diarrhea, which improved with a gluten-free diet, in addition to chronic renal insufficiency, hypothyroidism, and aortic stenosis. Physical examination revealed diffuse erosions with grouped papules and vesicles on his bilateral extremities, elbow and knee extensors, chest, back, buttocks, face, and scalp (Figure 1). Examination also revealed extensive excoriations, as well as superficial honey-colored crusts. A few possible burrows were noted on his wrists.

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