June 2002


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History: The patient is a 42 year-old black female with a history of dry, thick, scaly rash since infancy, that varies in severity over time (Figs 1,2). Occasionally she has also noted nonpruritic erythematous rashes, particularly over her torso. Previously, she has been treated unsuccessfully for presumed atopic dermatitis with triamcinolone ointment. She does report that she has had some relief with Salicylic acid gel and Tazorac gel. Her past medical history includes Graves disease. Current medications include Synthroid, Tazorac gel, triamcinolone ointment, and Doxepin. The patient has a sister with similar complaints.

 

Physical Exam: 42 year old well developed, well nourished, black female with lichenified, hyperpigmented, hyperkeratotic, symmetric plaques over much of her upper torso, upper arms, and lower shins with accentuation along the flexural areas. The patient's face, scalp, eyes, and lips were unremarkable. No erythematous patches were noted on initial exam.


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