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78-Year-Old Female with Rash on Hands and Face

Can you diagnose this case?

David L. Kaplan, MD

Signs and Symptoms

This 78-year-old woman presented with a several-month history of a rash on her hands and face that had failed to respond to topical ketoconazole cream. Laboratory blood tests results were normal except for an antinuclear antibody titer of 1:80. She was otherwise healthy.

What is responsible for the rash on this woman’s hands and face?

Choose one to reveal diagnosis and discussion

Seborrheic dermatitis
Psoriasis
Dermatomyositis
Cutaneous lupus erythematosus
Contact dermatitis

Answer: Cutaneous lupus erythematosus

See the full case at Consultant360

This patient was felt to have an underlying connective tissue disease, based on the rash’s clinical appearance as well as the results of a skin biopsy that were suggestive of a connective tissue disease based on the presence of an interface dermatitis. The patient was given hydroxychloroquine as a therapeutic challenge with subsequent improvement.

Seborrheic dermatitis, psoriasis, and contact dermatitis would be expected to be pruritic and to have more scaling than is seen here. The patient was more likely to have cutaneous lupus erythematosus than dermatomyositis given that lupus is more common and that she did not have the muscle pain and weakness commonly associated with dermatomyositis.