A 56-year-old man with diffuse erythema


DAVID EFFRON, MD--Series Editor--and SEAN M. ROTH, DO, DPM

THE CASE: A 56-year-old man presents with diffuse erythema. He has not changed his routine or eaten anything unusual. The rash initially appeared the previous night as asymptomatic erythema on the face and body. On awakening in the morning, the patient noticed that the erythema had spread over most of his body and had become pruritic. Over-the-counter diphenhydramine did not relieve the symptoms.

The patient has asthma, for which he uses albuterol as needed. He has no known allergies. He is a smoker and drinks alcohol occasionally; he denies exposure to other drugs or potential irritants. There is no family history of similar rashes, and the patient states that normally his skin is clear.

Examination reveals that the erythema covers the patient's entire body. Several annular papules are noted on the anterior aspect of the thighs and knees. Diffuse scaly eczematous lesions are present on the face and the dorsal aspect of the feet.

On further questioning, the patient recalls that he has had this type of rash twice before in the past 20 years. His condition was extensively worked up both times, but no definitive diagnosis was made.

What is the likely cause of the rash?

  • Cutaneous drug eruption
  • Psoriasis
  • Contact dermatitis
  • Atopic dermatitis