38. A 34-year-old man presents with a chronic and progressive skin rash

  1. A 34-year-old man presents with a chronic and progressive skin rash. He has a history of poorly controlled Crohn’s disease and has lost 20 lb in the past 6 months. On examination, there are dry, scaly patches and plaques, which are sharply marginated and bright red around his mouth, and anogenital regions. There is
    also involvement of the flexural regions of the arms. Which of the following is the most likely diagnosis?

(A) ichthyosis
(B) acquired zinc deficiency
© Paget’s disease
(D) candidiasis
(E) herpes simplex

solution:

  1. (B) It is a persistent dermatitis around the mouth, with acral involvement that begins as vesicles but is soon crusted. Later it goes on to involve the scalp, hands and trunk, and feet. Treatment is zinc replacement in the diet. It has been described after prolonged parenteral alimentation, malabsorption states, intestinal
    bypass surgery, and chronic alcoholism. There is an inherited form (autosomal recessive) of the syndrome called acrodermatitis enteropathica. The inherited form occurs in infants and is also treated with zinc.

A 26-year-old woman develops discomfort on her lower legs and notices a skin rash. On examination, there are tender nodules on hershins with an erythematous base. Which of the following conditions is this rash associated with?

(A) caused by aspergillosis
(B) usually occurs in children
© more common in males than females
(D) only caused by malignant disease
(E) can occur with streptococcal infection

  1. (E) Erythema nodosum is a hypersensitivity vasculitis associated with many infections, drugs, alignancies, and inflammatory conditions (sarcoidosis). The peak age is 20–30 and it occurs more commonly in females. The lesions are rare in children. It is a nodular erythematous eruption, usually on the extensor aspects of the legs, less commonly on the thighs and forearms. It regresses by bruise-like color changes in 3–6 weeks without scarring.