case_images: PMC10108407_01
case_images: On initial consultation, there is significant erythema, scaling, and lichenification involving 70% body surface area (BSA), including the face, trunk, and extremities.
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case_images: PMC10108407_01_10.1177_2050313X231164271-fig1.jpg
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case_images: On physical examination, there was significant erythema, scaling, and lichenification involving 70% body surface area (BSA), including the face, trunk, and extremities (Figure 1).
case_images: After 3 months of therapy, he had dramatic improvement of his pruritus and approximately 75% improvement in his skin with few residual eczematous patches and plaques on the face, neck, and arms.
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case_images: PMC10108407_01_10.1177_2050313X231164271-fig2.jpg
case_images: fig2-2050313X231164271
case_images: After 3 months of therapy, he had dramatic improvement of his pruritus and approximately 75% improvement in his skin with few residual eczematous patches and plaques on the face, neck, and arms (Figure 2).
case_images: There are extensive erythematous patches and plaques with yellow exudative crusting involving the scalp, beard, and face.
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case_images: PMC10108407_01_10.1177_2050313X231164271-fig3.jpg
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case_images: On examination, there were extensive erythematous patches and plaques with yellow exudative crusting involving the scalp, beard, and face (Figure 3).
case_images: The punch biopsy of skin of the scalp shows irregular acanthosis with underlying papillary dermal fibrosis. There is a mixed inflammatory infiltrate within the papillary dermis with lymphocytes and eosinophils. The overlying stratum corneum shows orthokeratosis admixed with areas showing prominent neutrophilic involvement with a few neutrophils. Rare eosinophils are seen within the epidermis. (a) Punch biopsy of the scalp, hematoxylin and eosin (H&E) staining, magnification 40x and (b) punch biopsy of the scalp, H&E staining, magnification 400x.
case_images: 10.1177_2050313X231164271-fig4.jpg
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case_images: The biopsy demonstrated spongiosis with eosinophilia, consistent with AD or possibly allergic contact dermatitis (Figure 4).