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July 1997

A Persistent Periorificial Eruption

Author Affiliations

George Washington University, Washington, DC

Arch Dermatol. 1997;133(7):909-910. doi:10.1001/archderm.1997.03890430129019

REPORT OF A CASE  A 74-year-old woman with a history of hypertension and refractory anemia presented with a 23-kg weight loss over 6 months, generalized weakness, and a progressive eruption involving the elbows, arms, buttocks, perineum, and oral commissures. Despite therapy with systemic steroids, antibiotics, and topical agents, the patient's cutaneous eruption and constitutional symptoms worsened. She was then hospitalized for a medical workup.Physical examination revealed an elderly, cachectic woman with generalized pallor and an abdominal mass. Erythematous, erosive patches with adherent large, brown scales, maceration, and fissures were present in the perineal and gluteal areas (Figure 1). Periorificial (Figure 2) and acral erythema with scales and fissures were also present.A skin biopsy specimen from the patient's left arm (Figure 3) showed marked epidermal atrophy alternating with slight acanthosis and confluent overlying parakeratosis with numerous neutrophils. The patient was hospitalized for further medical evaluation.What is your

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