LaRochelle Joseph M, Dimitriades Victoria R
College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana, USA.
School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Dermatopathology (Basel). 2020 Jan 17;6(4):237-240. doi: 10.1159/000505357. eCollection 2019 Oct-Dec.
Contact dermatitis and psoriasis are common skin disorders which represent two distinct pathologies. Skin disorders heavily rely on corresponding history for diagnosis; this case demonstrates the challenges of relying on history alone for final identification. A patient presented to clinic for evaluation of a new rash on his abdomen. Past medical history was notable for recent initiation of a smoking cessation program utilizing nicotine patches as well as a pharyngitis treated with antibiotics 1 week prior. Despite use of topical steroid and cessation of the patches, the well-demarcated rash became more generalized. Patch testing for the nicotine patch and chemical sensitizers was negative and an eventual biopsy was consistent with guttate psoriasis. Contact dermatitis relies heavily on clinical history for diagnosis. This case demonstrates that history can be misleading. In retrospect, it is likely that a preceding presumed streptococcal infection was the primary inducer of guttate psoriasis.
接触性皮炎和银屑病是常见的皮肤疾病，代表两种不同的病理状况。皮肤疾病在很大程度上依赖相应病史进行诊断；本病例展示了仅依靠病史进行最终确诊的挑战。一名患者到诊所评估其腹部出现的新皮疹。既往病史显示近期开始使用尼古丁贴片进行戒烟计划，以及1周前因咽炎接受了抗生素治疗。尽管使用了外用类固醇并停用了贴片，但边界清晰的皮疹变得更加泛发。对尼古丁贴片和化学致敏原的斑贴试验为阴性，最终活检结果符合点滴状银屑病。接触性皮炎在很大程度上依赖临床病史进行诊断。本病例表明病史可能具有误导性。回顾来看，很可能先前假定的链球菌感染是点滴状银屑病的主要诱发因素。
