Hingtgen Grace M, Milanovic Silvija, Portillo-Romero Jessica
Department of Dermatology, University of Florida College of Medicine, Gainesville, USA.
Department of Internal Medicine, University of Florida College of Medicine, Gainesville, USA.
Cureus. 2025 Jan 3;17(1):e76869. doi: 10.7759/cureus.76869. eCollection 2025 Jan.
While topical steroids are an invaluable tool used for the treatment of pruritic rashes, they can also complicate attempts at a definitive diagnosis. The temporal association between steroid use and biopsy must be taken into account when investigating the underlying etiology of such rashes. In patients with a history of dermatologic disease with the onset of a new rash, management should include a biopsy, if deemed necessary for diagnosis, followed by a prescription of topical steroids for symptomatic treatment. A 63-year-old male with a history of psoriasis presented with a new-onset pruritic, erythematous-to-violaceous rash on sun-exposed areas. The final diagnosis of subacute cutaneous lupus erythematosus (SCLE) was delayed due to the use of topical steroids on cutaneous eruptions before presentation in the clinic for biopsy. Diagnosis of SCLE can be difficult, especially for primary care providers who do not see the initial presentation regularly, as cutaneous findings can be variable in presentation. However, recurrent eruptions in similar photo-distributed locations should alert providers of a potential underlying diagnosis and prompt referral for dermatologic evaluation should be suggested. Thorough personal and family history should be taken and photographs of the rash should be documented in the patient's chart for future reference. Ultimately, biopsy is the gold standard diagnostic method for evaluating the etiology of new-onset rash. When there is suspicion of an underlying disease beyond idiopathic contact or irritant dermatitis, a biopsy should be considered as the next best step in management.
虽然局部用类固醇是治疗瘙痒性皮疹的一种非常宝贵的工具，但它们也可能使明确诊断的尝试变得复杂。在调查此类皮疹的潜在病因时，必须考虑类固醇使用与活检之间的时间关联。对于有皮肤病病史且出现新发皮疹的患者，如果诊断认为有必要，管理措施应包括活检，然后开具局部用类固醇进行对症治疗。一名63岁男性，有银屑病病史，在暴露于阳光的部位出现新发的瘙痒性、从红斑到紫红色的皮疹。由于在到诊所进行活检之前，对皮肤皮疹使用了局部用类固醇，亚急性皮肤型红斑狼疮（SCLE）的最终诊断被延迟。SCLE的诊断可能很困难，尤其是对于不经常见到初始表现的初级保健提供者来说，因为皮肤表现可能各不相同。然而，在类似的光分布部位反复出现皮疹应提醒提供者可能存在潜在诊断，并建议及时转诊进行皮肤科评估。应详细询问个人和家族病史，并将皮疹照片记录在患者病历中以供将来参考。最终，活检是评估新发皮疹病因的金标准诊断方法。当怀疑存在特发性接触性皮炎或刺激性皮炎以外的潜在疾病时，活检应被视为下一步最佳管理措施。
