September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 54 year old man presented with a widespread itchy eruption that had developed over a few weeks. There was no prior history of skin problems or relevant family history. The patient had a long history of depression and had been taking venlafaxine for four years and lithium for approximately two years. He had no relevant hobbies.
A widespread rash comprised of many violaceous firm papules and flat-topped nodules. The lesions had a little surface scale but there were no other surface changes. There were no nail or mucosal changes.
What is the differential diagnosis?
The appearances were similar to lichen planus but not entirely typical so a biopsy was carried out. The biopsy was in keeping with a lichenoid drug reaction.
Lichenoid drug reactions:
In this case it was felt likely that lithium was the cause of the rash so an urgent psychiatric review was requested. Given the relatively stable mood of the patient and the severity of the rash the decision was taken to carefully withdraw the lithium. The patient's mood remained stable and the rash gradually resolved over the next three months.
Please refer to the relevant chapter on Drug rashes - mild to moderate for further information.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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