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Unusual Erythematous and Infiltrated Plaque


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Am Fam Physician. 2015 Nov 1;92(9):821-822.

A 30-year-old man presented with an erythematous plaque on his left forearm. The plaque began as vesicles and was pruritic. The area was mildly infiltrated and had a particular pattern (Figure 1). He had applied an ornamental tattoo five days prior to the development of the rash, and the rash did not spread beyond the border of the tattoo. His medical history was unremarkable.

Physical examination revealed a raised erythematous lesion with a distinct border. The surrounding skin was normal. The patient was treated with a high-potency topical steroid cream. A hyperpigmented macule persisted for three weeks, but there was no sign of local relapse or neuralgia after six months.

Figure 1.


Based on the patient's history and radiologic findings, which one of the following is the most likely diagnosis?

A. Contact dermatitis.

B. Herpes zoster.

C. Koebner phenomenon.

D. Symptomatic dermographism.

Address correspondence to Pablo Fernández-Crehuet, MD, PhD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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3. Kind F, Scherer K, Bircher AJ. Contact dermatitis to para-phenylenediamine in hair dye following sensitization to black henna tattoos - an ongoing problem. J Dtsch Dermatol Ges. 2012;10(8):572–578.

4. Breathnach SM, Allen R, Ward AM, Greaves MW. Symptomatic dermographism: natural history, clinical features laboratory investigations and response to therapy. Clin Exp Dermatol. 1983;8(5):463–476.

5. Kontou-Fili K, Borici-Mazi R, Kapp A, Matjevic LJ, Mitchel FB. Physical urticaria: classification and diagnostic guidelines. An EAACI position paper. Allergy. 1997;52(5):504–513.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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