May 2013







History: 59 year old South Asian female with stage IV breast cancer presented complaining of a three week history of a slightly scaly reddish brown rash that was primarily limited to her face and neck.  Her metastatic breast cancer was being treated with Xeloda (Capecitabine) and she was receiving a third cycle at the time.  The patient denied itching, pain, or bleeding but had moderate fatigue.  She noted that she does not get much sun exposure but does not use sunscreen.  She wears long sleeves and pants when she goes out of doors. She noted some sores in the mouth, which resolved with Magic Mouthwash


Past Medical History:  stage IV breast cancer, hypertension, recurrent depression Medications:  Capecitabine, Lisinopril, Zometa, Abilify, Magic Mouthwash Allergies: NKDA 

Physical Exam: On the head and neck are erythematous annular scaly plaques with a slightly pigmented center surrounded by non-blanching erythematous border (Figs.1-3).  Extremities: Hyperpigmented papules and patches of distal extremities.




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