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28-Year-Old Male with Pruritic Patch on Arm

Can you diagnose this case?

David L. Kaplan, MD

Signs and Symptoms

This 28-year-old man presented for evaluation of an enlarging pruritic patch on his arm that had developed over a 4-month period. His only medications were fluticasone and azelastine, which he takes to treat seasonal allergies. He uses only his hands, not a washcloth, to bathe, and he does not apply any topical creams or lotions. He does not have pets, and he denies any other exposure history.

What is responsible for this man’s rash?

Choose one to reveal diagnosis and discussion

Eczema
Tinea corporis
Psoriasis
Drug reaction
Contact dermatitis

Answer: Eczema

See the full case at Consultant360

This atopic patient (based on his use of medications for seasonal allergies) had developed nummular eczema as a result of his bathing habits—long, hot showers and a lack of moisturizing—which resulted in the asteatosis seen here.

He was instructed on how to bathe and moisturize to maintain skin integrity after applying a short course of a topical corticosteroid cream.

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