How Do You Solve a Problem Like This Leg Rash?
Author and Disclosure Information [Show]

Joe R. Monroe, MPAS, PA, ­practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Phyisican Assistants.

For a decade, this woman has struggled to find relief for her leg rash. How can you identify the solution?

Question 1 of 1

How Do You Solve a Problem Like This Leg Rash?

Over the past 10 years, this now 52-year-old woman has seen several different primary care providers for evaluation of a rash on her leg. The latest, after labeling the problem a resistant fungal infection, refers her to dermatology.

During her decade-long odyssey, the patient has been prescribed innumerable topical and oral medications, including corticosteroid creams, foams, and ointments and antibacterial creams (eg, triple-antibiotic cream and mupirocin). She also has taken several courses of oral prednisone, which helped for the duration of treatment; alas, upon cessation, the rash would promptly reappear. Modest relief from itching was achieved with some of the products tried--particularly, the topical steroids.

The pink, scaly rash covers most of the medial aspect of her left foot and calf. On the latter is a round, scaly, well-defined plaque. A similar rash covers the rim of her right foot but does not extend upward onto the calf. No other rashes or skin abnormalities are noted.

The patient's overall health has been reasonably good, considering her history of smoking (30+ pack-years) that led to early COPD. She lives with her husband and her elderly mother; there are no pets or children in the household.

A reasonable next step to diagnosis would be to perform:

A KOH prep, looking for fungal elements

A swab culture for fungal organisms

A punch biopsy, including the history and differential on the requisition

All the above

Clinician Reviews. 2019 January;29(1):1e-2e

This quiz is not accredited for CME.

More from DermaDiagnosis


She Wants to Whack all the Moles
Giving a Rash the Boot
A Line Redefining His Jaw
Child Has a Black Mark Against Him
The Lesion Didn’t Bother Him—Just Everyone Else
Get the Dirt on This Skin Condition
Facing up to the Problem
Don’t Take These Lesions at Face Value
Not the Sole Rash on Him
Whatever You Do, Don’t Touch It
Are These Lesions Getting Out of Hand?
When the Scales Align
Bullae for You, My Dear
Tag! (That’s Not It)
"Berry" Red Cheeks
When Insurance Is a Nuisance
Now You See It …
Ring Around the ... Footsie?
If It’s Purple and Perplexing, It Must Be …
The Yeast (Infection) That Won't Cease