PMC10108407_01
On initial consultation, there is significant erythema, scaling, and lichenification involving 70% body surface area (BSA), including the face, trunk, and extremities.
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On physical examination, there was significant erythema, scaling, and lichenification involving 70% body surface area (BSA), including the face, trunk, and extremities (Figure 1).
After 3 months of therapy, he had dramatic improvement of his pruritus and approximately 75% improvement in his skin with few residual eczematous patches and plaques on the face, neck, and arms.
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After 3 months of therapy, he had dramatic improvement of his pruritus and approximately 75% improvement in his skin with few residual eczematous patches and plaques on the face, neck, and arms (Figure 2).
There are extensive erythematous patches and plaques with yellow exudative crusting involving the scalp, beard, and face.
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On examination, there were extensive erythematous patches and plaques with yellow exudative crusting involving the scalp, beard, and face (Figure 3).
The punch biopsy of skin of the scalp shows irregular acanthosis with underlying papillary dermal fibrosis. There is a mixed inflammatory infiltrate within the papillary dermis with lymphocytes and eosinophils. The overlying stratum corneum shows orthokeratosis admixed with areas showing prominent neutrophilic involvement with a few neutrophils. Rare eosinophils are seen within the epidermis. (a) Punch biopsy of the scalp, hematoxylin and eosin (H&E) staining, magnification 40x and (b) punch biopsy of the scalp, H&E staining, magnification 400x.
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The biopsy demonstrated spongiosis with eosinophilia, consistent with AD or possibly allergic contact dermatitis (Figure 4).