Dermatology: Practical and Conceptual


Quiz  |  Dermatol Pract Concept 2014;4(4):6 37

DERMATOLOGY PRACTICAL & CONCEPTUAL
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Case

A 50-year-old African-American female with a past medical 

history significant for human immunodeficiency virus (HIV) 

and non-adherence to HAART therapy, was admitted for 

failure to thrive and a generalized, pruritic skin eruption. The 

patient first noticed the eruption on her feet a few months 

prior to admission. Within days, it had spread to her torso, 

upper extremities, and scalp. On physical examination, she 

had well-demarcated, erythematous and scaly, confluent 

plaques involving the torso, upper and lower extremities (Fig-

ure 1). In addition, she had thick, hyperkeratotic plaques on 

the palms and soles as well as dystrophic fingernails (Figure 

2). Skin scrapings were performed and histopathology evalu-

ation was obtained (Figure 3).

What is your diagnosis?

Generalized, pruritic skin eruption in 
an immunocompromised patient

Stephanie Wang1, Juliana Basko-Plluska1, Maria M. Tsoukas1

1 Department of Dermatology, University of Illinois at Chicago, Chicago, USA

Citation: Wang S, Basko-Plluska J, Tsoukas MM. Generalized pruritic skin eruption in an immunocompromised patient. Dermatol Pract 
Concept. 2014;4(4):6. http://dx.doi.org/10.5826/dpc.0404a06

Received: June 20, 2014; Accepted: June 25, 2014; Published: October 31, 2014

Copyright: ©2014 Wang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

All authors have contributed significantly to this publication.

Corresponding author: Maria M. Tsoukas, MD, PhD, Department of Dermatology, University of Illinois at Chicago, Chicago, USA. Tel. 
312.996.6966. Email: tsoukasm@uic.edu

Figure 1. Well-demarcated, erythematous and scaly, confluent plaques on the patient’s back. (Copyright: ©2014 Wang et al.)



38 Quiz  |  Dermatol Pract Concept 2014;4(4):6

Diagnosis

Given the clinical and histopathological findings, a diagnosis of 

tinea corporis in an immunocompromised patient was made.

Clinical course

The patient was treated with fluconazole 100 mg daily for 3 

months. Her eruption improved within days of starting the 

therapy.

Discussion

Tinea corporis is a dermatophyte infection of the skin. Fac-

tors that determine severity of clinical disease include the 

immune system of the host, the inhibitory effect of sebum, the 

presence of mannans in the cell walls of dermatophytes and 

their immune-inhibitory effects, as well as keratinases, which 

allow invasion of fungi into the stratum corneum. Differential 

diagnosis included and was not limited to crusted scabies, 

psoriasis and sebo-psoriasis, nutritional deficiency. Exten-

sive tinea corporis requires systemic therapy with antifungal 

medications. Standard treatments include terbinafine 250 mg 

daily for a week, fluconazole 150-200 mg per week for 2-4 

weeks, itraconazole 200 mg daily for 1 week, or griseofulvin 

500–1000 mg/day (microsize) or 375–500 mg/day (ultrami-

crosize) for 2–4 weeks. In immunocompromised patients, a 

longer course of therapy may be indicated.

Figure 2. Thick, hyperkeratotic plaques on the palms and dystrophic 

fingernails. (Copyright: ©2014 Wang et al.)

Figure 3. Punch biopsy, skin at the back: numerous hyphae in the 

stratum corneum and a superficial, mixed perivascular infiltrate 

were evident on histopathologic examination. (Copyright: ©2014 

Wang et al.)