CASE 1: A 13-year-old Caucasian girl sought treatment for a pruritic, scaling patch on her right cheek. The patient had a 10-year history of atopic eczema, with rashes primarily in flexural areas, and a history of skin reactions to earrings and rivets in her blue jeans. She had gone 3 years without a rash on her earlobes and periumbilical areas by scrupulously avoiding contact with metal.
The 2 x 2-cm patch of pruritic, scaling, lichenified skin with focal excoriation that brought her in on this day had been on her right cheek for the past 3 months ( FIGURE 1 ). It had not responded to hydrocortisone 2.5% cream and desonide 0.05% cream when she applied it twice daily, nor had it responded to an intralesional injection of 2 cc of 2.5 mg/cc triamcinolone acetonide.
CASE 2: A 13-year-old African American girl with a history of atopic dermatitis went to her doctor for a rash beneath the umbilicus. She’d had the rash, which she said was extremely itchy, for 6 weeks; over the previous 10 days, it had become more widespread. A 6 x 5-cm scaling, lichenified, hyperpigmented plaque was present in the infra-umbilical region. She also had a papular rash on the dorsal hands and axillae.
CASE 3: A 15-year-old Caucasian girl sought care for a pruritic, erythematous rash circumscribing her left wrist in an 8-mm diameter band. She’d had the rash for 6 weeks.
CASE 4: A 58-year-old Caucasian woman presented with a pruritic, erythematous, scaling rash on both upper cheeks just below her lower eyelids. She told the physician that she had a similar pruritic rash on her earlobes when she wore costume jewelry.
CASE 5: A 50-year-old woman went to her doctor for a pruritic, erythematous patch on the anterior and posterior sides of her ear-lobes, bilaterally. She told the physician that her ears had been pierced 2 weeks earlier.
WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU MANAGE THIS CONDITION?