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55-Year-Old Female with Two Different Skin Issues on Arms

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A 55-year-old female presented for evaluation of 2 problems. She initially made the appointment for the flat, reddish-brown, asymptomatic plaques that had appeared on her arms and legs 4 months prior. In the last 2 days, she had also developed very itchy, red papules on her arms. She is otherwise healthy.

Which of the following combinations do you suspect?

Choose one to reveal diagnosis and discussion

Contact dermatitis & lichen planus
Lichen planus & granuloma annulare
Granuloma annulare & bed bug bites
Contact dermatitis & granuloma annulare
Dermatomyositis & bed bug bites

Answer: Granuloma annulare & bed bug bites

See the full case at Consultant360

These flat, reddish-brown circular plaques are granuloma annulare, a benign asymptomatic condition more common in women. It runs a self-limited course and does not require treatment, which is fortunate, as it does not respond to any treatment in a consistent manner.

The 3 papules in a row are suggestive of bed bugs. A patient history confirmed recent exposure history due to her work with the homeless.

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