Lahey Clinic Department of Dermatology
Monthly Grand Rounds
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