Asteatotic Eczema on Legs and Steroid Rosacea on Face

April 16, 2008

For several years, a 71-year-old man has had a mildly pruritic rash on his legs that develops every winter and resolves when the weather becomes warmer. He is scheduled to undergo knee surgery, but the surgeon refuses to perform the operation until the rash has cleared.

Case 1:

For several years, a 71-year-old man has had a mildly pruritic rash on his legs that develops every winter and resolves when the weather becomes warmer. He is scheduled to undergo knee surgery, but the surgeon refuses to perform the operation until the rash has cleared.

 

What does this look like to you?A. Asteatotic eczema.
B. Ichthyosis.
C. Psoriasis.
D. Stasis dermatitis.
E. Leukocytoclastic vasculitis.

(Answer on next page.)

Case 1: Asteatotic eczema

Further questioning revealed that this patient scrubbed his legs with a washcloth, which contributed to the asteatotic eczema, A. By changing his bathing habits and applying a mid-potent topical corticosteroid cream, he was able to undergo surgery within 2 weeks.

 

Ichthyosis has the appearance of fish scales; this asymptomatic condition occurs year-round but is aggravated by dry weather. Psoriasis typically consists of well-defined patches and plaques of scale and erythema. Stasis dermatitis appears similar to this patient's eruption but is associated with pitting edema, which is absent here. Leukocytoclastic vasculitis presents with a petechial or purpuric eruption that does not resemble this patient's rash.

 

Case 2:

A 34-year-old woman presents with a facial eruption of 2 months' duration. The outbreak initially cleared after she applied a topical corticosteroid cream that had been prescribed for her husband. However, the eruption recurred despite continued treatment and has slowly worsened. The patient is otherwise healthy.

What do you suspect?A. Acne.
B. Rosacea.
C. Perioral dermatitis.
D. Steroid rosacea.
E. Contact dermatitis.

(Answer on next page.)

Case 2: Steroid rosacea

This patient has steroid rosacea (also known as steroid acne), D, which results from the use of a mid- or higher-potency topical corticosteroid for longer than 1 month. The reaction can persist for up to 6 weeks before it resolves. Treatment consists of discontinuation of the offending corticosteroid. Patients may also benefit from traditional rosacea therapy or the use of a nonsteroidal agent, such as pimecrolimus or tacrolimus.

The patient's history of corticosteroid use ruled out acne and rosacea. The eruption did not occur in the typical distribution of perioral dermatitis, and the patient had no history of contactant exposure.