A patient has a rough, circular, 1-cm lesion on her outer calf. The lesion has small punctate areas within, no erythematous appearance, and is not uniformly raised. The patient states that the area weeps at times. Biopsy showed chronic dermatitis with psoriasiform epidermal hyperplasia (chronic psoriasiform dermatitis). No vasculitis, significant atypia or evidence of malignancy was seen. Stains were negative for fungal microorganisms. We are trying a course of topical steroids to see if they will affect the area. What is our next step?—JUNE HITE, RN, MSN, CFNP, Brownwood, Tex.
Topical corticosteroids are a reasonable choice for the initial management of a biopsy-confirmed “chronic psoriasiform dermatitis.” Since the lesion is on the leg, a mid- to high-potency corticosteroid would be appropriate. A cream-based preparation absorbs more readily and is often preferred by the patient; if the lesion persists, an ointment-based preparation (which is more occlusive yet often not as cosmetically appealing to the patient) can be used. Initially use the topical corticosteroid twice a day for seven to 14 days and then once daily for three to seven days. Thereafter, a moisturizing cream should be applied once or twice daily. If the lesion persists, intralesional corticosteroid treatment might be considered.—Philip R. Cohen, MD (147-11)