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Old 03-15-2012
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Skin Three circular plaques on the leg

A 20-year-old man presents to his primary care physician for a lesion on his right leg. It is intensely pruritic and has been present for the last 10 days. Initially, the lesion began as a series of small vesicles and papules, which have now coalesced. He has a history of bronchial asthma and uses Albuterol as required. Physical examination reveals three circular plaques on the right extensor surface of the lower leg that are 4 to 5 cm in diameter with an erythematous base and well-defined borders. One plaque has developed an exudative crust. Excoriations are present. What is the most likely diagnosis?

A. Atopic dermatitis
B. Dermatitis herpetiformis
C. Nummular dermatitis
D. Pityriasis rosea
E. Tinea corporis

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Old 03-15-2012
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Default C

I would guess nummular eczema, based on the location, the exudative crust, the coalescing, and the history of asthma
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Old 03-15-2012
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Default Nummular eczema


The diagnosis of nummular dermatitis is made on the basis of observing the characteristic round-to-oval erythematous plaques. They are most commonly located on the extremities, particularly the legs, but they may occur anywhere on the trunk, hands, or feet. Nummular dermatitis does not involve the face and scalp. Lesions are often symmetrically distributed.

Patients present with a days-to-months' history of a pruritic eruption, usually starts on the legs. It may also burn or sting.

Nummular dermatitis often waxes and wanes with winter; cold or dry climates or swings in temperature may be exacerbating factors. It may improve with sun or humidity exposure or with moisturizer use. Occasionally it may worsen with heat or humidity.
New nummular dermatitis lesions often recur in the same locations as old lesions.
The patient's medical history may be positive for eczema, atopic dermatitis, or dry and sensitive skin.


Distinguishing between forms of dermatitis (eg, asteatotic eczema, atopic dermatitis, nummular dermatitis) may be difficult, but, fortunately, this is not necessary to make proper treatment decisions. Contact dermatitis may have a pattern that approximates the manner in which the offending agent came into contact with the skin, such as a linear pattern. It may become chronic in the setting of repeated exposure, such as with chromates and formaldehyde. The patient may recall contact with an allergen, such as poison ivy.

Lichen simplex chronicus often occurs on the lower legs, the neck, the scalp, or the scrotum; it is lichenified (thickened by chronic scratching), more violaceous, and, often, has no clear border.

Stasis dermatitis may occur simultaneously on the lower extremities, and venous stasis may lead to the concomitant development of both conditions.

Psoriasis plaques are often found on the extensor surfaces, especially at the elbows and knees, in addition to other areas. The scalp is often involved. Psoriasis scale is usually thick and silver and bleeds when removed (Auspitz sign).
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Old 03-16-2012
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its Nummular dermatitis. Atopic dermatitis is usually found on the flexor surfaces unlike nummular that the plaques are found on the extensor surfaces but both of them are intensely pruritic.
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Dermatology-, Step-2-Questions

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