Race for the Case

Race for the Case is a clinical quiz feature published quarterly in Directions in Residency — and right here!

Review the case and photos, and submit your answers to the questions below. If you answer correctly, you'll be entered to win a $25 Starbucks gift card. Free coffee and pastries are on the line — what are you waiting for?

perforating disorder

A 65-year-old African-American male presents with a several month history of extremely pruritic, circular, clustered plaques on the lower extremities with firmly adherent, depressed, concentric circular crusts and surrounding mild erythema. His past medical history is significant for end stage renal disease on hemodialysis x 2 years, type II diabetes mellitus requiring insulin, COPD, severe coronary artery and peripheral artery disease, rheumatoid arthritis managed on prednisone 15mg daily, and recurrent Clostridium difficile colitis s/p bowel resection.

Case submitted by Robyn Marszalek, MD, a PGY-4 dermatology resident at Boston University Medical Center.

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This condition is classified under an 'umbrella' category which encompasses four clinical variants. What is the name of this umbrella category? What are the names of the four conditions in the category?
What element(s) in this patient's past medical history may predispose to this condition?
What are histopathologic findings that all four clinical variants share?
For each clinial variant, what is the primary unique substance see on histopathology that clinches the diagnosis?
What are felt to be cutaneous triggers of this eruption?
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Make your diagnosis for a chance to win a Starbucks gift card!

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