Ami Saraiya, MD Raveena Reddy, MD Robert Brodell, MD Northeast Ohio Medical University, Rootstown (Dr. Saraiya); University of Mississippi Medical Center, Jackson (Drs. Reddy and Brodell); University of Rochester School of Medicine and Dentistry, NY (Dr. Brodell)
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
Dr. Brodell serves on speaker’s bureaus for Galderma, PharmaDerm, Veregen, and AbbVie, has served as a consultant for Galderma Laboratories LP, and has been on multicenter clinical trials for Genentech. Drs. Saraiya and Reddy reported no potential conflict of interest relevant to this article.
Our patient had initially been given a diagnosis of subacute spongiotic dermatitis. But the rash didn’t respond to treatment. Another lab test revealed why.
An 8-year-old girl was brought into our clinic for evaluation of a leg rash on her right lower leg that had been bothering her for 2 months. Another physician had performed a biopsy and diagnosed subacute spongiotic dermatitis, but the rash did not respond to treatment with triamcinolone cream 0.1% twice daily.
The rash was mildly tender and markedly pruritic. The girl had no history of trauma, prior skin conditions, or other areas with a similar rash. Physical examination revealed concentric annular lesions on the right lower leg (FIGURE). The central areas demonstrated a bruised appearance that did not resolve with diascopy.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
