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60-Year-Old Female with Rash on Chin and Back

Can you diagnose this case?

David L. Kaplan, MD

Signs and Symptoms

This 60-year-old woman presented for evaluation of a rash on her chin of several months’ duration. When questioned, she reported also a history of rashes on her back that were itchy. She was otherwise healthy.

Which of the following explains this patient’s lesions?

Choose one to reveal diagnosis and discussion

Nummular eczema
Contact dermatitis
Dermatophyte infection
Cutaneous lupus erythematosus
Asteatotic eczema

Answer: Cutaneous lupus erythematosus

See the full case at Consultant360

This patient had biopsy-proven cutaneous lupus erythematosus. She was placed on hydroxychloroquine, which resulted in marked improvement of all lesions. The laboratory workup did not reveal any internal or systemic involvement.

Nummular eczema and asteatotic eczema are not uncommon on the trunk, but involvement of the face should suggest expanding the differential diagnosis. A dermatophyte infection this extensive would be highly unusual in a patient in this age group. The appearance and the anatomic location of the lesions in this case argue against contact dermatitis.

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