| Introduction: |
| A 19 year old man was evaluated for a chronic diffuse itchy, scaly, hyperpigmented rash. |
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| History: |
| The eruption began 2-3 years earlier on the back of his neck and gradually spread to the back and chest. The patient's 18 year old brother developed a similar rash on the neck, chest, back, and abdomen. He experienced minimal improvement with emollients, topical steroids, and lactic acid 10% lotion.
His past medical history was significant for tonic-clonic seizures and depression for which he received olanzapine(Zyprexa), citolapram(Celexa), nizatidine(Axid), venlafaxine hydrochloride(Effexor), and carbamazepine(Tegretol). There was a family history of depression. |
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| Clinical
Presentation: |
| There were confluent and reticulated hyperpigmented plaques with overlying scale covering the back of the neck, back, chest, and lower abdomen. Velvety hyperpigmented thickening of the skin was noted on the sides of the neck, axillae, and over the bony prominences of the arms and legs |
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| Pathology: |
| Skin biopsies from the posterior neck and lower back showed papillomatosis, mild epidermal acanthosis, and hyperkeratosis. High power demonstrated thinning of the stratum granulosum, occasional melanophages in the papillary dermis and minimal perivascular lymphocytic infiltrate. |
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| Question
1: |
| What is the most likely diagnosis in this patient? |
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| Question
2: |
| How would you evaluate him? |
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| Question
3: |
| How would you treat this condition? |
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