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JAMA Oncology Clinical Challenge
April 2018

Gradually Worsening Pruritic Plaques

Author Affiliations
  • 1Department of Internal Medicine, Hurley Medical Center, Flint, Michigan
  • 2Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint
JAMA Oncol. 2018;4(4):573-574. doi:10.1001/jamaoncol.2017.3735

A woman in her 20s previously prescribed and currently taking valproic acid and phenytoin for epilepsy presented to the clinic with a 2-month history of gradually worsening pruritic plaques that initially involved the scalp, face, and neck, and later affected the anterior and posterior chest wall, abdomen, upper arms, and thighs; she also had nodules over the nose and cheeks (Figure 1A).