Pruritic Rash With Alopecia
Nova Southeastern University / North Broward Hospital District, Ft.
Lauderdale, FL
June, 2002
Presenters:
Peter A. Vitulli, Jr. D.O. ( 2nd Year Resident)
Steven Moreno, D.O., Eric Adelman, D.O. (1st Year Residents)
Program
Director: Stanley Skopit, D.O.
Clinical Presentation
Patient: 78 years old African American Male
History
A 78 year old African American male presents to the
dermatology clinic with a nine year history of a progressively
expanding, mildly pruritic rash on his neck and face. He states the
eruption began on his neck and spread to his face. In addition, he
complains of progressive hair loss and a chronic cough. He had not
sought previous medical attention for this condition.
Past Medical History - Hypertension.
Past Surgical History - none
Allergies - PCN
Family History - non-contributary
Social History - lives with wife; has two sons; denies tobacco and
illicit drug use
Current Medication
Adalat 30mg QD
Physical Exam
Examination reveals mildly erythematous scarring
alopecia extending from the front of the scalp to the occiput, sparing
the temperoparietal areas. The forehead, bilateral cheeks, jawline, and
neck reveal multiple discrete , annular rings of grouped, firm papules
with central atrophy. There are no other suspicious lesions noted on the
rest of his body
Figure 1 to Figure 3. (click image to zoom)
Laboratory Tests
All labs within normal limits except for an
elevated ACE level of 92 IU/L.
CXR reveals bilateral hilar adenopathy
Dermatohistopathology
Microscopic description: Biopsy of scalp:
Superficial and deep granulomatous perifolliculitis.
Special stains negative for microorganisms.
Biopsy of Left Neck: Noncaseating granulomatous dermatitis.
Special stains negative for microorganisms.
Differential Diagnosis
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