Jump to content
In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2758 - 1 February 2021 Posted By: Richard Logan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

F22. Sore, dry rash on legs for several weeks.


  Report Record

User Feedback


Dr. Mona Abdel-Halim

Posted

Some visitors in the stratum corneum?!

Share this comment


Link to comment
share_externally

Krishnakumar subramanian

Posted

I don't know. let me wait for the answer

Share this comment


Link to comment
share_externally

Eman El-Nabarawy

Posted

? Fungal infection. Xerotic eczema..acquired ichthyiosis..

Share this comment


Link to comment
share_externally

I know erythrasma on flexural regions...so I don’t know what it could be. Waiting for the answer. 

Share this comment


Link to comment
share_externally

Richard Logan

Posted

This is a case from my archives from about 20 years ago.  At that time there was a small outbreak of irritant contact dermatitis due to exposure mainly to the antiseptic agent benzalkonium chloride.  This was present at a concentration of 6% in a bath emollient commonly prescribed at that time.  Most of the cases therefore occurred in patients with eczema whose barrier function was impaired and who were at greater risk of this complication.

Patients typically developed a reddish-brown, dry, hyperkeratotic eruption especially in body folds or at other sites exposed to the benzalkonium (see clinical picture).

Histologically the changes are confined to the stratum corneum with little or no underlying inflammation.  This has been described as "granular parakeratosis" although I must admit that the parakeratosis is not well reproduced in these slides.

Your suggested alternative diagnoses are all very sensible.  I presented this case to illustrate an example of "top heavy" histology which should always suggest an exogenous cause.

A relevant report was by Saw NK and Hindmarsh JR: Postgrad Med J 2005;81:131–132. doi: 10.1136/pgmj.2003.018564

Benzalkonium irritant reation.jpg

Share this comment


Link to comment
share_externally



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...