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Intermittent back rash
Pt is a 23 yo Caucasian male presenting with a rash over the entirety of his back with blotchy concentration on the lateral area over the latissimus dorsi and solid concentration over the shoulder area. The rash is red in nature, does not itch, is not raised. The severity comes and goes without known cause, but remains constantly. Presentation began 2 months ago and has increased in severity since.
Pt has no known food or drug allergies. Pt is not taking any prescription medication or recreational drugs; however, he has just finished a prednisone dose regiment. Pt consumes alcohol weekly. No significant change in diet. Pt works out 6 to 7 days a week with an average of 12 hours weekly. He swims 3 days a week, lifts weights 2 days a week, runs 3 to 4 days a week and cycles 3 days a week.
Antibiotic cream and hydrocortisone cream were applied without significant changes in presentation.
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Looks like typical monomorphic steroid induced acne. Would like to know why he was given prednisolone?
Regards.
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Prednisone was given to treat impingement in the left shoulder due to inflammation of the supraspinatus. Rash developed before the dosage of prednisone.
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Also notice the white blotchy area in between the scauplae and on the upper right shoulder. That is the color of the normal skin and the darker red pigmentation is the affected area.
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Oh yes I did see the hypopigmentation(apparently normal skin) and assumed it to be tinea versicolor since the patient does hard exercise and likely to sweat. the papuls are indeed telltale signs of steroid therapy.
Does the area blanch the blotchy area?
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Yes, the area does blanch with pressure. Upon further research of both disorders, your diagnosis looks to be correct. The following image is very similar to the lesions along the sides of the back over the lats and the solid lesions at the top match the other description of the tinea versicolor.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002436/figure/A001465.B1890/?report=objectonly

Pt has had a more extreme outbreak of the monomorphic steroid induced acne over the left deltoid since first publication.
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Do get your friend treated and he should be fine.
Cheers!
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Thank you.

What treatment should be used for the acne?
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A course of vitA for 10 days.

(contraindication for high dose in females during pregnancy-just for information!), and calamine for application
Good wishes..
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