Is a new pet to blame for these itchy annular lesions?

Case 2:
After 6 weeks of coping with itchy lesions on her arms and legs, a 43-year-old woman seeks medical advice. The rash first erupted with the onset of cold weather. The patient recently acquired a dog.

(Answer on next page.)

Case 2: Nummular eczema

This patient with atopy and a history of seasonal allergies, E, bathed with scented soap, B; used a washcloth, A; and failed to apply moisturizer, C, consistently. Nummular eczema, H, resulted. She was the only family member to complain of itching, D.

It is unlikely that a dermatophyte infection would produce multiple lesions; typically only 1 or 2 highly inflamed lesions occur when a dog or a cat is the source of ringworm. If in doubt, perform a potassium hydroxide evaluation to rule out a dermatophyte.

Contact dermatitis arises on exposed areas of the body; because of the cold weather, the patient’s arms and legs had been covered. Pityriasis rosea occurs on the trunk and psoriasis affects the knees and elbows, which were clear in this patient.

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