August/September 2015

 

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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

 

Social Hx:

Tobacco: has smoked two packs per day since age 17

Denies alcohol or IVDU

 

Family Hx:

Noncontributory

 

Allergies:

Augmentin

 

Medications:

Alprazolam

Cyclobenzaprine

Pramipexole

Paroxetine

Quetiapine

Zolpidem

 

Physical exam:

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).

 

 

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