22 year old female presents to a dermatology office with complaints of a rash on her upper back and legs. There is severe pruritus (itching)

22 year old female presents to a dermatology office with complaints of a rash on her upper back and legs. There is severe pruritus (itching) present. Patient also complains off diaphoresis at night. These symptoms have been going on for 4 weeks and have gotten progressively worse. Patient has tried using over-the-counter anti-fungal cream (Lamisil) and Ammonium Lactate lotion. Patient’s past medical history includes facial acne which is controlled with regular dermabrasion and history of pediculosis in childhood which was successfully treated with complete shaving of the head. Patient’s surgical history is significant for a Pilonidal Abscess which was treated by incision and drainage. Patient’s family history includes seborrheic keratosis in her father which are routinely treated with cryotherapy, history of long-standing diabetes in her mother resulting in peripheral neuropathy and below knee amputation due to non-healing ulcer, and multiple sclerosis in her maternal grandmother resulting in a decubitus ulcer secondary to immobility. Patient’s medications include Loratadine, Ortho-Tricycline, and Multivitamin. On exam patient is in moderate distress. There is generalized erythematous maculo-papular rash involving the epidermal layer on her upper back and lower extremities. There are two areas of 4 cm wheals on the upper back as well. There is no evidence of ecchymosis, petechia or lymph node enlargement. Assessment/Plan: Will perform shave biopsy of the rash. Continue anti-histamine (Loratadine). Add Triamcinolone cream twice daily. Stop Keratolytic. Will follow-up following results of the biopsy.

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