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March 1993

A Pruritic Eruption With Reticular Pigmentation

Author Affiliations

Northwestern University Medical School, Chicago, Ill, and University of Chicago School of Medicine

Arch Dermatol. 1993;129(3):370. doi:10.1001/archderm.1993.01680240113021

REPORT OF A CASE  A 17-year-old boy presented with a 12-month history of an intensely pruritic eruption on his back and neck. Previous treatment with acyclovir, nafcillin, hydroxyzine, and cimetidine orally did not affect the pruritus or alter the eruption; neither did topical fluocinonide, desonide, and hydrocortisone. He felt well, had no significant medical history, and was taking no medications except hydroxyzine at the time of presentation. His family had no history of a similar eruption.On physical examination, the patient had excoriated erythematous and hyperpigmented keratotic papules distributed in a reticulate pattern covering most of the midback (Fig 1) and scattered on the lateral aspect on his neck. His physical examination was otherwise unremarkable.Histopathologic examination of lesional skin showed elongation of epidermal rete ridges, focal spongiosis, exocytosis, liquefaction degeneration of the basal cell layer, and an edematous papillary dermis (Fig 2). Direct immunofluorescence was performed on a skin

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