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How Would You Diagnose This Rash on a Young Woman?

Nina Bhagat, DO• Anush S. Pillai, DO2,3

    1Resident Physician, Family Medicine Residency, HCA Houston Healthcare West, Houston, Texas
    2Program Director, Family Medicine, HCA Houston Healthcare West
    3Clinical Associate Professor, Department of Family Medicine, University of Houston College of Medicine, Houston, Texas

    Pillai AS, Bhagat N. How would you diagnose this rash on a young woman? Consultant. 2022;62(8):e10-e12. doi:10.25270/con.2021.09.00005

    Received April 12, 2021. Accepted April 13, 2021. Published online September 27, 2021.

    The authors report no relevant financial relationships.

    Anush S. Pillai, DO, HCA Houston Healthcare West, 12121 Richmond Avenue, GME Suite 402, Houston, TX 77082 (


    A 32-year-old woman presented for evaluation of a new rash on her upper and lower extremities, palms, and soles.

    She reported that the lesions had appeared 3 months prior to presentation, around the time that she started anticoagulation treatment with warfarin for newly diagnosed antiphospholipid syndrome that caused pulmonary emboli and deep vein thrombosis. The lesions had taken on a scaly appearance over time and were pruritic. She was subsequently switched to apixaban, but the rash persisted one month after switching to the new drug.

    The patient had no significant medical history other than the recent diagnosis of antiphospholipid syndrome and the associated venous thromboembolisms. She denied tobacco, alcohol, or drug use. Patient reported being sexually active with 2 men over the last year and has been using condoms inconsistently.

    Results of a physical examination revealed too-numerous-to-count, discrete, hyperpigmented macules and patches measuring approximately 0.5 to 1 cm in diameter scattered on the forearms, wrists, and palmar and plantar surfaces bilaterally (Figures 1 and 2). There was no involvement of oral or genital mucosa. A punch biopsy was performed during the visit, results of which showed nonspecific spongiotic change with rare plasma cells located perivascularly.

    Figure 1. Hyperpigmented patches on her feet
    Figure 1. Hyperpigmented macules and patches were noted on the patient’s feet.

    Figure 2. Hyperpigmented macules and patches were noted on the patient’s hands.
    Figure 2. Hyperpigmented macules and patches were noted on the patient’s hands.



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