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Nov 2011

Pruritic Scaly Rash on Arms and Legs —Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(11):1317-1322. doi:10.1001/archdermatol.2011.325-a

A 74-year-old woman presented with a pruritic scaly rash on her arms and legs that had progressed to involve the face, trunk, and scalp over a 30-year period. She denied systemic symptoms and did not note any variation with sun exposure. There was no family history of a similar eruption. Previous treatment with topical corticosteroids, psoralen –UV-A phototherapy, and broadband UV-B phototherapy was unhelpful. Examination revealed a widespread cutaneous eruption. The lesions on the arms and legs consisted of lichenoid violaceous papules and indurated nodules in a bilaterally symmetrical reticulate pattern (Figure 1). Lichenoid papules were also noted on the trunk, scalp, and palms. Erythematous papules with scaling were present on the midface (Figure 2). Distal onycholysis was seen on the left third fingernail. The oral mucosa and conjunctivae were not involved. Two skin biopsy specimens were obtained for histopathologic analysis (Figure 3).

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