HOW TO TAKE THE POST-TEST: This Clinical Advisor CME activity consists of 3 articles. To obtain credit, you must also read Slow-growing papule with no pain or itching and Thick, leathery, and red skin over the hands; the post-test will include questions related to all three articles.To obtain CME/CE credit, please click here after reading the articles to take the post-test on


A man aged 41 years was referred for evaluation of lesions on his legs, trunk and forearm. The lesions were first seen several months ago after the man lost his job, was threatened with divorce, began to drink heavily and gained 30 lbs. All of the lesions had grown in size and developed more scale. Pruritus was minimal but persisted despite OTC clotrimazole recommended by his pharmacist. Examination of the lesions showed several 1- to 8-cm annular, salmon-pink plaques covered with a thick, adherent white scale.

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A 50-year-old man noticed a small area of scaling on his forearm. Self-treatment with OTC hydrocortisone 1% cream reduced the itching, but the rash continued to grow over the next year. A pharmacist suggested tolnaftate cream, which only reduced the redness and itching slightly and seemed to worsen the problem. The primary-care clinician prescribed triamcinolone 0.1% cream t.i.d. After two months, the rash had grown to cover almost his entire dorsal forearm and itched even more. The man was then referred to dermatology.

What is the diagnosis?

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