HPI: A 58-year-old Caucasian woman presents with a one year history of a photo-exposed rash on her face, chest, neck, and legs. The rash is pruritic and uncomfortable with greater than 50% body surface area affected. A previous biopsy showed “actinic granuloma.” She has failed treatment with hydroxychloroquine, cyclosporine, acitretin, methotrexate, and apremilast.
PMH:COPD, Fibromyalgia, Chronic back pain, GERD
Recurrent syncopal episodes
Tobacco: has smoked two packs per day since age 17
Denies alcohol or IVDU
Photo-distributed, erythematous, annular plaques with elevated borders and slightly atrophic, hypopigmented centers, located on the posterior and anterior neck, chest, and extremities covering > 50% body surface area (Figures 1-4).
Click here for the Diagnosis.