A Rash of Rough Spinous Patches on a Young Girl

July 24, 2014

The rash has been present for 2 years. Originally on the trunk and extremities it has now spread to her face and hands. She has been diagnosed as having and been unsuccessfully treated for nummular eczema and tinea corporis. What's your Dx?

A 7-year-old girl with a 2-year history of moderately pruritic lesions on the trunk and extremities, presented with new lesions on the hands and face. When the lesions first developed two years earlier, she was diagnosed with nummular eczema and prescribed triamcinolone 0.1%; this provided mild relief from the pruritus but left the lesions otherwise unchanged. For the next year, she was seen numerous times for the same complaint, and was treated with clotrimazone 1% for possible tinea corporis and again with topical steroids for eczema. Lesions persisted and the patient was lost to follow-up until new lesions started cropping up on her hands and face, prompting another visit. The child is otherwise healthy and there is no known family history of heritable dermatologic conditions.

 

Physical examination revealed multiple spinous punctate papules grouped into dry, rough hypopigmented patches ranging from 1 to 4 centimeters in diameter (Figures 1 and 2). These were located mostly on the arms and legs with a few scattered on the back and abdomen; some had overlying excoriations. The new lesions on the hands and face (Figures 3 and 4) were less rough and scaly, and were flatter and less spinous.

What is the cause of this dermatologic condition?

A. Atopic dermatitis

B. Keratosis pilaris

C. Lichen spinulosus

D. Lichen planus

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A 7-year-old girl with a 2-year history of moderately pruritic lesions on the trunk and extremities, presented with new lesions on the hands and face. When the lesions first developed two years earlier, she was diagnosed with nummular eczema and prescribed triamcinolone 0.1%; this provided mild relief from the pruritus but left the lesions otherwise unchanged. For the next year, she was seen numerous times for the same complaint, and was treated with clotrimazone 1% for possible tinea corporis and again with topical steroids for eczema. Lesions persisted and the patient was lost to follow-up until new lesions started cropping up on her hands and face, prompting another visit. The child is otherwise healthy and there is no known family history of heritable dermatologic conditions.

Physical examination revealed multiple spinous punctate papules grouped into dry, rough hypopigmented patches ranging from 1 to 4 centimeters in diameter (Figures 1 and 2). These were located mostly on the arms and legs with a few scattered on the back and abdomen; some had overlying excoriations. The new lesions on the hands and face (Figures 3 and 4) were less rough and scaly, and were flatter and less spinous.

What is the cause of this dermatologic condition?A. Atopic dermatitis

B. Keratosis pilaris

C. Lichen spinulosus

D. Lichen planus

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