Granuloma annulare (GA) is a common, noninfectious granulomatous skin condition that usually presents in its localized form, characterized by flesh-colored to erythematous papules coalescing into annular plaques without scale, commonly on the dorsal hands. Lesions can be pruritic and often resolve without treatment in two years. However, the generalized form of GA has a lower incidence and presents with similar morphology, but with >10 lesions in a widespread distribution. Generalized GA is known to be more symptomatic, longer-lasting, and recalcitrant to treatment. The diagnosis is made based on clinicopathological correlation with palisading granulomas around degenerated collagen in the dermis, mucin, and infiltrative lymphocytes and histiocytes. Treatment remains challenging as evidence is limited to case reports, case series, and a few retrospective studies. Here we present the case of a 59-year-old Caucasian female with pruritic rash that began on her abdomen and spread to her extremities over two months. Biopsy revealed superficial histiocytic infiltrates palisading around eosinophilic areas of altered collagen, multiple multinucleate giant cells with elastophagocytosis and lymphohistiocytic perivascular infiltrates, and mucin in the dermis on colloidal iron staining. Overall, this was consistent with generalized GA. The patient was started on a combination of low dose naltrexone (LDN) and psoralen and ultraviolet A (PUVA) therapy. At a five-month follow up visit, she demonstrated near complete resolution of symptoms without any serious adverse effects.

Background Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. Objective This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. Methods This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. Results In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. Conclusions Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.

A 71-year-old man presented with an eruption on the face, shoulders, upper back, and arms of 3 weeks' duration. The lesions were asymptomatic, and he denied fever, chills, or weight loss. He had a history of type 2 diabetes mellitus, hypertension, and hypercholesterolemia. Physical examination revealed coarse facial features with purple-pink nodules on the face and trunk and ulcerated nodules on the upper extremities. Mucous membrane involvement was noted, and there was marked occipital and submandibular lymphadenopathy. A biopsy of an arm nodule revealed a superficial and deep dermal and periadnexal lymphocytic infiltrate of atypical CD3 + cells. THE BEST DIAGNOSIS IS: a. diffuse large B-cell lymphoma b. lepromatous leprosy c. Merkel cell carcinoma d. metastatic adenocarcinoma e. primary cutaneous γδ T-cell lymphoma