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33 year old indian with 9 month history of this recurrent rash which improves promptly on topical steroids only to relapse after stoping treatment. he works indoors, his only exposure to sun is when he is going to or from work. rash it asymptomatic, no joint pain or history of mouth ulcers. on examination he has multiple confluent scaly erythematous to violacious papules forming plaques. distributed on his cheecks and mid forhead , hands are free.
the problem is that he isnt eligible and cant afford to pay, i would hav asked for ANA and biopsy but since i would treat blindley, i might give him the following:
mid potency topical steroid+sunscreen+ antimalrial
oblviosly am thinking about lupus, but am afriad am missing sth else , polymorhus light eruption?
this is like a real morphology test.
ur thoughts are appreciated
Filed under: Uncategorized | Tagged: lupus
dermlive
dermis111
dr660
skindr
visitor111
epiderma
kamalsaleh
most probably lupus, but some lesions look hyperkeratotik , i would consider ulerthema ophryogens, if not responding to steroids try topical tretinoin.
The distribution on face, hand and feet make lichen planus actinicus at the top of the list , though the clinical lesions I see on face make me in favor of lupus miliaris disseminatus faciale or sarcoidosis. I will not give this patient any treatment with out skin biopsy
I do respect all the previous diagnoses mentioned above, but I want to add the phototoxic lichenoid drug eruption as a differential diagnosis.
will the patient denied any drug use, but admitted having only when he came 2 saudi. i saw him again he s much better on elocom and hydroxycrq , i gave him elidel 2 maintain that. like evrythin it improves only 2 come bacl later.