Sarah Bankhead, BS Jeremy Jackson, MD Robert Brodell, MD Louisiana State University Health Sciences Center, New Orleans (Ms. Bankhead); University of Mississippi Medical Center, Jackson (Drs. Jackson and Brodell); University of Rochester School of Medicine and Dentistry, New York (Dr. Brodell) rbrodell@umc.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
Ms. Bankhead reported no potential conflict of interest relevant to this article. Dr. Jackson serves on a speakers bureau for Celgene. Dr. Brodell serves on speakers’ bureaus for 3M/Graceway Pharmaceuticals, GlaxoSmithKline/Stiefel, Dermik/BenzaClin, Galderma Laboratories LP, Medicis, Novartis Pharmaceuticals Corporation, PharmaDerm, Sanofi-Aventis, Veregen, and AbbVie. He has served as a consultant for F. Hoffmann-La Roche AG and Galderma Laboratories LP, and has performed multicenter clinical trials for Abbott Laboratories, Dow Pharmaceutical Sciences, Galderma Laboratories LP, and Genentech.
The combination of a ring-shaped rash on the patient’s torso and a foot infection led us to the diagnosis.
An 86-year-old African American woman sought care for an asymptomatic rash on her back and flanks that she’d had for 14 months. Physical examination of her trunk revealed 3 to 6 cm annular/arcuate plaques with central clearing. The lesions also had a delicate trailing scale behind a slightly raised erythematous rim (FIGURE 1).
Further examination revealed that the patient had thickening and discoloration of her toenails (FIGURE 2), as well as moist scaling between the 4th and 5th toes of both of her feet.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
