Can you Diagnose this Common Rash in Young Adults?
May 13, 2015
A 31 year old male with no significant past medical history presents with a new rash over both his legs, arms and trunk. The rash (shown in the picture below) is described as multiple small scaly areas, and is only mildly itchy. Your patient states to have recovered from a “cold” about one month ago. Can you diagnose this based on the image? (Spoiler alert: answer below!)
Diagnosis: Guttate psoriasis
Guttate psoriasis is a common dermatologic finding in children and young adults (usually up to the age of 30). The physical exam showing multiple small (usually less than 1 cm) scaly lesions such as with this patient is usually enough to make the diagnosis.
The term “guttate” means resembling a drop and is indicative of the small drop-like distribution of this diagnosis that is usually seen on the trunk and proximal extremities. Extension to distal extremities and scalp can sometime be seen. Streptococcal infection often precedes the development of guttate psoriasis.
Treatment includes phototherapy, topical steroids and topical vitamin-D analogs. Often the rash will spontaneously resolve and supportive counselling is all that is needed.
The patient received various forms of topical steroids and topical vitamin D with moderate effect. After approximately 9 months, the lesions resolved spontaneously.
Watch this video to get a first-person perspective of the Examination of the Hand with Abraham Verghese.
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