Mary T. Sessums, BA Kimberley M.H. Ward, MD Robert Brodell, MD University of Mississippi Medical Center, Jackson (Ms. Sessums and Drs. Ward and Brodell); University of Rochester School of Medicine and Dentistry, NY (Dr. Brodell) rbrodell@umc.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
Ms. Sessums and Dr. Ward reported no potential conflict of interest relevant to this article. Dr. Brodell serves on speakers’ bureaus for AbbiVie, Allergan, Galderma, PharmaDerm, and Veregen, has served as a consultant for Galderma Laboratories LP, and has been on multicenter clinical trials for Genentech.
The cause of this “dirty” rash was fairly obvious to us, but only because we’d encountered this rare skin disorder before.
A 22-year-old African American man sought care at our clinic for an asymptomatic, “dirty-looking” rash on the epigastrium that had expanded and thickened over the previous 2 years. The rash hadn’t responded to scrubbing with soap and water, ammonium lactate lotion 12% BID, or over-the-counter moisturizing lotions.
Brown, hyperkeratotic papules and plaques with central confluence and a peripheral reticulated appearance covered a 30 × 20 cm area on the patient’s upper abdomen and lower chest at the midline (FIGURE). A similar, milder rash appeared in a 6 cm area at the midline of his upper back.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
