A 61-year-old Caucasian man sought care for a rash that he’d had on and off for the past 5 years. He’d seen several physicians, but none had been able to make a diagnosis. Topical antifungal creams and steroids provided some improvement, but the rash would always come back.
Upon examination, the patient’s rash was limited to his trunk. Multiple scaly macules and papules (FIGURE 1) formed scabs and healed, leaving behind hyperpigmented skin. The patient noted that the rash was occasionally itchy. He also mentioned that he’d had a flare-up 4 to 5 months earlier, when he’d been visiting Beijing. That flare-up had lasted 2 to 3 months.
The patient was otherwise healthy and had no personal or family history of atopy or skin disease.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?