69 y/o female with longstanding h/o atopic dermatitis with severe flares

    Lahey Clinic Department of Dermatology

     

     

    Monthly Grand Rounds

    PATIENT PROTOCOL

    Presenters: __Siobhan Mannion, M.D.

    Reason for Presentation: (diagnosis, therapy, interest) Diagnosis & Therapy

    Chief Complaint: Flare of eczematous dermatitis

    Pertinent History: 69 y/o female with longstanding h/o atopic dermatitis with severe flares, most pronounced on face and neck

    Lab Data/Histopathology: 2006 ANA + 1:80 speckled. Negative anti Ro and La Ab.

    PATH REPORT 4/17/08 punch biopsy right upper forehead & right posterior neck:

    Rt upper forehead - perivascular and spongiotic dermatitis with lymphocytic infiltrate and scattered eosinophils

    Rt posterior neck - changes are those of a subacute dermatitis, suggestive of a hypersensitivity reaction to drug, insect bite or other agents. An eczematous process is also possible

    Past Therapies: Elidel, topical cortiosteroids, emollients

    Pertinent Physical Exam: Diffuse eczematous dermatitis of face with ectropion. History of eczematous dermatitis on chest, hands, and antecubital fossa.

    Presumptive Diagnosis: Atopic dermatitis vs chronic actinic dermatitis

    Possible Therapies: Azathioprine, sunscreens

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