Scaly Red Plaques in a 22-Year-Old Man

Authors:
Jason Le, DO
Naval Flight Surgeon for Command Training Air Wing 1 at Naval Air Station Meridian, Mississippi

Michael S. Dent, MD
Dermatology Clinic Department Head and Staff Dermatologist at Naval Hospital Pensacola, Florida

Citation:
Le J, Dent MS. Scaly red plaques in a 22-year-old man. Consultant. 2019;59(12):371-374.

Disclaimer:
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

A 22-year-old male student naval aviator presented with a 1-week history of an eruptive nonpruritic rash that had started on the upper and lower extremities. He had been evaluated at an urgent care facility at the time and had been given permethrin for presumed scabies, without noted improvement, as well as a short course of oral corticosteroids. Of note, he had had an episode of pharyngitis within the previous 2 months that had since resolved.

A few weeks later, he presented for evaluation to his primary care provider, at which time the lesions had worsened and had spread to his torso. He was started on topical and oral antifungals without noted improvement. On subsequent follow-up, physical examination showed 3-mm to 5-cm, round, palpable, erythematous papules and plaques with overlying white scale on the extremities, trunk, hands and feet (including palms and soles) but without lesions on the genitals, head and neck, or mucosae (Figures 1 and 2).