Unusual rash with histiocytic infiltrate

    47 year old male with a history of psoriasis presented to the dermatologist with two asymptomatic red brown dome shaped papules on the abdomen.

    The lesions had been present for several weeks and given their banal appearance further evaluation and treatment was held.

    In the ensuing weeks similar lesions appeared exponentially spreading centrifugally from his trunk to his extremities and face until hundreds of iridescent papules speckled his body

    Physical exam showed 3 to 8 mm papules most prominent on his trunk but also present in head, neck and extremities.

    CT scan was normal, bone marrow was normal.

    Patient was treated narrowband UVB two to three times per week until his goal of 1800 mj/cm2 was reached.

     

    After 30 treatments most of the skin lesions flattened with several dozen recalcitrant lesions.  He bought a  light box and more recalictrant lesions were removed.

     

    Case to be discussed at upcoming Dermpedia Cutaneous Hematopathology CME Course in Scottsdale, AZ