Three circular plaques on the leg - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
USMLE Articles
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam

Thread Tools Search this Thread Display Modes
Old 03-15-2012
tyagee's Avatar
USMLE Forums Master
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
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

Give reason
Reply With Quote Quick reply to this message

Old 03-15-2012
USMLE Forums Master
Steps History: 1+CK+CS
Posts: 590
Threads: 31
Thanked 1,233 Times in 411 Posts
Reputation: 1257
Default C

I would guess nummular eczema, based on the location, the exudative crust, the coalescing, and the history of asthma
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (03-16-2012)
Old 03-15-2012
dr.digant's Avatar
USMLE Forums Addict
Steps History: Step 1 Only
Posts: 127
Threads: 21
Thanked 103 Times in 53 Posts
Reputation: 113
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).
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr.Lacune (08-15-2012), Mondoshawan (03-16-2012), tyagee (03-16-2012), usmlepak (03-16-2012), yarasara77 (07-17-2012)
Old 03-16-2012
USMLE Forums Veteran
Steps History: 1 + CK
Posts: 234
Threads: 63
Thanked 128 Times in 63 Posts
Reputation: 158

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.
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (03-16-2012)


Dermatology-, Step-2-Questions

Quick Reply

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Please enter a password for your user account. Note that passwords are case-sensitive.
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Where you live. Leave blank if you don't want to tell.


Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Similar Threads
Thread Thread Starter Forum Replies Last Post
curd like plaques in 4mth old infant Seetal USMLE Step 2 CK Forum 16 10-06-2011 02:56 AM
Intense SPECT circular focus in the left liver lobe! USMLE-Syndrome USMLE Step 2 CK Forum 4 06-28-2011 01:38 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)