Will the Real Tinea Please Stand Up …

4. For three months (since the long, cold winter), this man has had very itchy lesions on his legs that he often scratches vigorously. He is not atopic and has no new pets, but he does admit to being “addicted” to sitting in his new hot tub. Examination of the patient’s legs, particularly his calves, shows discrete and confluent round, scaly plaques of a striking reddish orange hue.

Diagnosis: Nummular eczema (NE), an extremely common condition, especially in older men with dry skin made drier by bathing habits, swimming, or use of hot tubs. But many cases appear without these conditions, causing much conjecture about potential triggers, such as contact versus irritant dermatitis. Indeed, the multiplicity of topical medications applied by this patient was probably making things worse, as is often the case. NE typically manifests acutely, but can persist for months. If need be, a 4-mm punch biopsy will rule out the other suspects in the differential diagnosis.

For more information on this case, see “Family Thinks Man has Worms.” Clin Rev. 2010;20(8):6.