Peer Reviewed
What is responsible for the rash on this woman’s hands and face?
This 78-year-old woman presented with a several-month history of a rash on her hands and face that had failed to respond to topical ketoconazole cream. Laboratory blood tests results were normal except for an antinuclear antibody titer of 1:80. She was otherwise healthy.
What is responsible for the rash on this woman’s hands and face?
- Seborrheic dermatitis
- Psoriasis
- Dermatomyositis
- Cutaneous lupus erythematosus
- Contact dermatitis
Answer on next page.
Answer: Cutaneous lupus erythematosus
This patient was felt to have an underlying connective tissue disease, based on the rash’s clinical appearance as well as the results of a skin biopsy that were suggestive of a connective tissue disease based on the presence of an interface dermatitis. The patient was given hydroxychloroquine as a therapeutic challenge with subsequent improvement.
Seborrheic dermatitis, psoriasis, and contact dermatitis would be expected to be pruritic and to have more scaling than is seen here. The patient was more likely to have cutaneous lupus erythematosus than dermatomyositis given that lupus is more common and that she did not have the muscle pain and weakness commonly associated with dermatomyositis.
David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.