A Recurring Rash on an Older Man’s Thigh

AUTHORS:
Logan J. Kolb, DO¹ • Leon Kou² • Yasser Faraj, DO³ • Karthik Krishnamurthy, DO^4,5

AFFILIATIONS:
¹Department of Dermatology, Olmsted Medical Center, Rochester, Minnesota
²Medical Student, Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
³Advanced Dermatology and Cosmetic Surgery, Orlando Dermatology, Orlando, Florida
⁴Medical/Surgical and Cosmetic Dermatology, Parks Dermatology Center, Palm Coast, Florida
⁵Department of Internal Medicine and Dermatology, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia

CITATION:
Kolb LJ, Kou L, Faraj Y, Krishnamurthy K. A recurring rash on an older man’s thigh. Consultant. 2022;62(7):e12-e13. doi:10.25270/con.2021.09.00001

Received April 12, 2021. Accepted April 15, 2021. Published online September 20, 2021.

DISCLOSURES:
Dr Krishnamurthy has a financial relationship with Regeneron, Sanofi-Genzyme, Abbvie Janssen, and Eli Lilly, which produce or market products or services relevant to the topic of this manuscript.

CORRESPONDENCE:
Leon Kou, Des Moines University College of Osteopathic Medicine, 3200 Grand Avenue, Des Moines, IA 50312 (k.leon@ucla.edu)

A 70-year-old man with a medical history significant for type 2 diabetes and hidradenitis suppurativa presented to our dermatology clinic with a pruritic and painful rash on the left posterior thigh. The rash first started 10 years prior to presentation and had numerous flares since onset, some of which included bullous lesions that persisted for days at a time.

The patient denied prior trauma or burns to the affected area. Hidradenitis suppurativa was diagnosed 11 years prior to presentation and was treated with multiple courses of doxycycline. The patient’s last doxycycline course was started a day before the lesion’s most recent appearance.

Physical examination findings revealed an oval, erythematous, scaly plaque measuring 8 × 6 cm with central circular erosions and areas of sparing (Figure 1). The patient denied fevers, night sweats, weight loss, fatigue, adenopathy, or anorexia. A punch biopsy was performed.

Figure 1. Well-demarcated purple oval plaque with central circular areas of clearing and superficial erosions

Answer and discussion on next page.