This is 78 year old patient who has type diabetes which is c | Figure 1

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This is a 78 year old patient who has type diabetes which is controlled on insulin. He started with this kind of rash initially scattered then increased and rash is very itchy. He has applied many local creams and has taken antihistamines and few of his medications were stopped thinking being culprits but it did not improve. It did respond some with prednisone.

Cases

Case 1

this 40yo male bodybuilder has been struggling with this rash the past month. It initially did respond to topical antifungals but has only worsened since starting oral antifungals. It’s itchy especially the one around the neck. As he is a physique athlete a rash obviously is concerning so any help is much appreciated!

Case 2

Patient is a 32 year old male with hypertension treated with one antihypertensive (patient did not know name). Presented for the first time 3 weeks ago with the above non-pruritic rash that he had for several days located on his right forearm. He had tried OTC hydrocortisone which apparently made it worse. He denied any new exposure or sick contacts or travel. He has no rashes anywhere else. He feels fine otherwise. He was started on keflex which fully resolved the rash in a few days. Today he presents again with an identical rash on the opposite arm (not pictured). How would you treat?

Case 3

25 year old male presents to the clinic with a rash in the nasal folds bilaterally. Pt states this rash has been persistent for 2+ months and is non responsive to any treatment. Pt states the rash is non itchy and nothing makes it better or worse. Pts states he has tried OTC topical docosanol, bactrum, anti fungal and hydrocortisone but with no improvement. Pt admits to no other symptoms and only complains that the rash is visibly noticeable. Pt has no medical conditions and takes no medications. Pt had varicella as a child. Pt does admit that his partner also did have a similar rash eruption at the same location but it has since resolved and was much milder. Pt admits he is under a lot of stress recently. Thoughts on tx?

Case 4

A skin Lesion on the right leg. The lesion is hyperchromic, well delimited and it has a desquamation of surface. Patient complains of intense itching at the site. He was treated with ketoconazole, but without improvement. Male patient, 50 years old. He has high blood pressure and diabetes. He is using Losartan 50 mg/day and Insulin NPH 32 IU/day. What is the diagnosis?

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