Pruritic lesions

Skin A 23-year-old woman, who was allergic to penicilhn, developed erythematous, fissured, scaly, pruritic lesions on the backs of the fingers and both hands after working as a prosthodontist for 1 month [77" ]. Patch testing was positive only with manganese, which is used in the manufacture of dental prostheses as a nickel substitute. 

Fig. 4. Airborne allergic contact dermatitis to propacetamol (Pro-Dafalgan) in a female nurse prior to injection into the infusion set. Erythematous, intensely pruritic lesions of the face, with marked malar oedema...

An 89-year-old man who had used over-the-counter topical antiseptics developed pruritic lesions over his left knee after using a topical medication containing benzalkonium chloride, dibucaine hydrochloride, chlorphenamine maleate, naphazoline hydrochloride, and a mixture of fragrance ingredients. There were pruritic erythematous papules and vesicles over the knee, and linear extensions down the lower leg appeared the next day. The dermatitis was successfully treated with topical glucocorticoids. Subsequent patch testing of the over-the-counter antiseptic was positive. 

Folliculitis presents as small, pruritic, erythematous papules. Location of the lesions and a good patient history are often all that are required in the diagnosis of folliculitis. While the papules may be cultured and Gram stains or potassium hydroxide stains done to help determine causative agent, it is not generally required because folliculitis often resolves spontaneously within a few days. 

The skin lesions of dermatitis may or may not be painful or pruritic. Typically, lesions are described as being less than or greater than 0.5 cm in diameter. 

Secondary Pruritic or nonpruritic rash, mucocutaneous lesions, flu-like symptoms, lymphadenopathy Latent Asymptomatic... 

Lichen planus is a condition of unknown aetiology presenting as small pruritic and shiny papules, which initially may appear purple in colour. It affects the limbs, wrists, trunk, genitalia and the mouth, in which case ulcerated lesions occur on the gingival tissue. Treatment for lichen planus involves the use of systemic antihistamines but sometimes corticosteroids are required. 

A 47-year-old postmenopausal woman developed eczematous lesions at the sites of application of an estradiol transdermal system and subsequently at the sites of application of an estradiol gel (55). She was therefore given oral estrogen instead, but this promptly elicited a systemic pruritic rash. The causal link was in all instances confirmed by patch-testing. 

Characterized by subcutaneous nodules, a pruritic skin rash and ocular lesions often resuiting in biindness. 

A 17-year-old boy took amfebutamone (dose unstated) for attention deficit disorder and 1 week later developed a generalized pruritic rash, but continued to take amfebutamone (27). After a further week he presented as an emergency with large joint tenderness and joint swelling. A punch biopsy of a skin lesion showed urticaria with vasculitis. Amfebutamone was withdrawn and a single dose of methylprednisolone sodium succinate was given. His symptoms resolved completely within 36 hours. 

A 24-year-old man with acute malaise and fever had a pruritic rash with multiple erythematous circumscribed weals on the trunk, arms, legs, neck, and scalp. He admitted to using intranasal cocaine 6 months, 4 days, and 1 day before the onset of the symptoms. His temperature was 39° C. His erythrocyte sedimentation rate was 80 mm in the first hour, C-reactive protein was 283 mg/1 (reference range below 10), and the white blood cell count was 12.4 x 109/1 with 89% neutrophils. A biopsy of an urticarial lesion showed a perivascular inflammatory infiltrate in the upper and middle dermis. Bed rest, oral prednisone, oral hydroxyzine, and topical polidocanol led to improvement within 24 hours. 

A 72-year-old woman was treated for thoracic Herpes zoster with oral aciclovir and topical benzocaine 20% ointment. She subsequently developed painful pruritic erythematous dermatitis in the area of the lesions, spreading to her arm. The dermatitis was initially misdiagnosed as aciclovir resistance, but on patch testing she had a positive reaction to benzocaine. 

A 59-year-old woman presented with a 1-month history of non-pruritic papules on the dorsa of both feet (83). During the previous year she had repeatedly received acupuncture in this area. A biopsy showed mixed lichenoid, spongiotic, and granulomatous dermatitis. Ultrastructural examination showed macrophages containing silicone. At follow-up new lesions on her mid calves were noted, and again she explained she had recently received acupuncture at these sites. 

Bullous pemphigoid has been reported in an 84-year-old man after topical therapy with fluorouracil 1% solution daily over several days for actinic keratosis. All treated lesions became bullous, with the development of a few bullae on untreated areas of normal skin. Bullous lesions were pruritic and sore and some contained hemorrhagic fluid. There was a leukocytosis (11.7 x 10 /1). The blister fluid contained predominantly eosinophils, and immuno-fluorescent studies of the serum and blister fluid showed anti-basement membrane antibody titers of 1 640 and 1 160 respectively. Fluorouracil was discontinued and the patient was treated with steroids and saline compresses, with abatement of symptoms (119). 

A 40-year-old woman with metastatic breast cancer received cychc snbcntaneons G-CSF for chemotherapy-induced neutropenia. After 5 months she had a pruritic rash at injection sites. She did not change the injection sites and the lesions recnrred after each injection. Biopsy showed a lichenoid reaction and the lesions healed with residual pigmentation after topical steroid application and G-CSF discontinuation. GM-CSF was well tolerated. 

A spectrum of cutaneous lesions has been described distant from sites of interferon alfa injection. The clinical and histological characteristics of inflammatory skin lesions that occurred away from injection sites have been investigated in 20 patients treated with interferon alfa-2a or 2b plus ribavirin for chronic hepatitis C (299). Cutaneous lesions developed between 2 weeks and 4 months and consisted of pruritic papular erythematous eruptions with occasional vesicles. These eczema-like skin lesions predominated on the distal limbs, the head, and the neck. Photosensitivity was also noted in four patients and mucous lesions in two. Skin biopsy mostly showed non-specific mononuclear infiltrates. The skin lesions were promptly reversible in 10 patients who required treatment withdrawal, while others improved after symptomatic treatment. Two of the three patients who again received the same or another type of interferon alfa had recurrence of their lesions. Skin tests performed in six patients were negative, including the two patients who relapsed after rechallenge with interferon alfa, and were therefore considered unhelpful. 

Granulomatous dermatitis with disseminated pruritic papules and histological features resembling those of sarcoid granulomas has been described in a 57-year-old man who received interferon beta-lb (58). The first lesions were observed after 2 months of treatment, persisted for 2 years, and slowly improved after interferon beta withdrawal and treatment with hydroxychloroquine PUVA. 

A 65-year-old Caucasian woman developed a localized skin eruption within hours of using ketoprofen gel on her knees to relieve arthralgia (187). The lesions were pruritic, well-demarcated, and erythematous, and later became studded with vesicles and small bullae. Histology and immunopathology suggested autoimmune pemphigus. 

A previously healthy 35-year-old man with conjunctival irritation had fluorescein dye instilled using a fluorescein-treated ophthalmic strip and isotonic saline. Within 30 minutes he began to notice a pruritic rash around his eye and on his arms, chest, and legs. His joints felt swollen. He had a diffuse erythematous macular rash with evidence of moderate excoriation over his arms and legs. His wrists and ankles were swollen. There were no oral lesions, and all laboratory studies, including the white blood cell count, were normal. Methylprednisolone succinate 125 mg plus diphenhydramine 50 mg produced rapid improvement. 

A 55-year-old man with chronic hepatitis C presented with a pruritic papular eruption on the trunk lasting 2 weeks. He had multiple, erythematous, excoriated papules on the neck, trunk, upper arms, and thighs. The lesions appeared 2 weeks after combination therapy with oral ribavirin and subcutaneous interferon alfa-2b. He had previously been treated with interferon alfa alone (in the same dosage). On withdrawal of ribavirin the lesions gradually faded, but they returned 1 week after reintroduction. 

A 45-year-old woman received topotecan and colony-stimulating factor for ovarian cancer and developed erythematous and slightly pruritic plaques on the upper and lower limbs and ear lobes about one week later (117). The lesions subsided spontaneously in about 10 days and recurred after the next dose. A skin biopsy showed neutrophilic eccrine hidradenitis all skin cultures were negative. 

A 52-year-old woman was given vancomycin 1 g intravenously bd and within 12 hours developed a generalized pruritic maculopapular rash (83). Over the next few days, the lesions progressively worsened and transformed into hemorrhagic and non-hemorrhagic vesicles and bullae. Mucosal surfaces, palms, and soles were spared. The skin lesions completely healed without scarring within 2 weeks of vancomycin withdrawal. There was no recurrence 5 months later. 

HPI JJ is a 50-year-old woman with metastatic lung cancer, s/p frontal-temporal craniotomy for resection of a metastatic brain lesion 2 days ago. JJ is complaining of a pruritic, erythematous rash on her back and arms that she denies having prior to admission. PMH Metastatic lung cancer s/p chemotherapy and radiation therapy 6 months prior. Presented 3 weeks prior to admission with a new onset generalized tonic-clonic seizure. 

The acute rash lesions are intensely pruritic, erythematous papules and vesicles over erythematous skin. These itchy lesions are subsequently associated with scratching that results in excoriations and exudates. Subacute lesions are typically thicker, paler, scaly, erythematous, and excoriated plaques. Chronic lesions are characterized by thickened plaques, accentuated skin markings (licheniflcation), and fibrotic papules. Most patients exhibit all three lesion types. At all phases, the atopic skin usually has a dry luster. ... 

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