Joana Sequeira, MD Diogo Pereira, MD Cláudia Rainho, MD Centro de Saúde Arnaldo Sampaio, Leiria, Portugal (Dr. Sequeira); Unidade De Saúde Familiar Flôr de Sal, Aveiro, Portugal (Dr. Rainho); Unidade De Saúde Familiar Maria da Fonte, Póvoa de Lanhoso, Portugal (Dr. Pereira) joanaseq@gmail.com
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
The authors reported no potential conflict of interest relevant to this article.
The location of the pruritic area on this patient’s back and the darkened patch that followed helped us to identify the cause of her chronic discomfort.
A 60-year-old woman visited our clinic complaining of an area on the right side of her middle back that was itchy, and had been bothering her for the past 10 years. She said her symptoms began without a trigger, and that a darkened area had appeared in the location of the itch. She had already been prescribed topical corticosteroids and antifungals and had tried over-the counter aids, but nothing relieved the itch. The patient had a history of cervical radiculopathy and was morbidly obese at the time of the visit.
On examination, the pruritic area consisted of a hyperpigmented, non-infiltrated 7-cm patch that was lateral to the vertebral column and within the dermatomes T4 to T6 (FIGURE). The patient also had hyperesthesia to light touch in this region and scratch abrasions.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
