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JAMA Oncology Clinical Challenge
February 20, 2020

Erythematous Patch With Central Papules on the Forehead of a Middle-aged Woman

Author Affiliations
  • 1University of Louisville School of Medicine, Louisville, Kentucky
  • 2Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
  • 3Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky
JAMA Oncol. 2020;6(4):578-579. doi:10.1001/jamaoncol.2019.6289

A 55-year old woman presented with a 6-week history of an enlarging, tender, pruritic, 4-cm erythematous patch with central inflammatory papules distributed on the medial forehead (Figure, A). No inciting events, such as arthropod bite or trauma, were noted. She was initially treated for presumed shingles with valacyclovir, cephalexin, gabapentin, and hydrocortisone 2.5% topical ointment with no improvement in appearance or symptoms. No other cutaneous abnormalities were noted. A punch biopsy specimen of the left medial forehead was obtained, and histological and immunohistochemical analyses were performed (Figure, B and C).

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