, Corinna Eleni Psomadakis2 and Bobby Buka3
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA
School of Medicine Imperial College London, London, UK
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
KeywordsDiscoid eczemaNummular eczemaDiscoid dermatitisAnnularRingContact allergyTopical corticosteroids
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Often misdiagnosed as ringworm, this circular plaque is less pruritic and has scale throughout
This coin-shaped lesion has a chapped appearance and is exceedingly common
(a and b) Follicular prominence is the first sign of xerosis , a clue to your diagnosis
Primary Care Visit Report
A 23-year-old female with past medical history of recurrent vaginal yeast infections, treated with weekly fluconazole 100 mg, presented with a pruritic rash. The rash started 2 weeks prior to this visit, with lesions on her right cheek (mostly resolved at visit), two round lesions on her right upper arm, a single lesion on her left shoulder area, and a rash on her upper thighs and abdomen. All lesions were pruritic and the patient reported a “burning, irritated” feeling on her legs. She had started using Tom’s soap for the first time about 1 month prior. Otherwise, no new skin products were reported.
Vitals were normal. On exam, there was a 5 mm × 5 mm round papular lesion with hyperpigmented border on her right upper arm, and a 1 cm × 1 cm scaly dry plaque with central clearing on her left upper arm. Her abdomen and bilateral thighs featured rough, papular, scaly dry plaques.
The considered differential was eczema versus a fungal infection. The patient was initially treated for eczema, and was prescribed topical desonide 0.05 % cream (Class VI) twice daily for 14 days. The patient was advised to discontinue use if the rash was not resolving with desonide, and instead try clotrimazole 1 % cream twice daily.
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