Question

1. A 28-year-old woman was referred to a dermatologist due to itchy patches under her arms and in the crook of her elbow.  The dermatologist notes the lesions are covered by a yellow-brown crust and are weeping exudate. When taking her history, the dermatologist notes the patient has not contacted any allergens, including plant oils such as poison ivy.  She is not feverish or showing any other outward signs of illness.  She has no prior history of allergy, nor is there a family history of allergy.  She admits to drinking a couple of glasses of wine daily after work and occasionally more on weekends.  She did smoke during college, but has not smoked for several years.  A thorough physical examination reveals similar lesions near her groin and behind the knees, although they are smaller and less troublesome.  The dermatologist takes a scraping from a lesion, draws blood and sends her home with a topical steroid.  

Examination of the scraping under a microscope showed it to be negative for fungus; which was confirmed by a negative mycological culture.  However, the scraping did show a marked neutrophilic infiltrate and her blood work indicated that while she was negative for rheumatoid factor she did have an erythrocyte sedimentation rate (ESR) of 32 mm/hr.  Her serum cytokine profile also indicated that she had a significantly elevated IL-8, IL-12, IL-17 and TNF-α level.  The circulating level of epidermal growth factor (EGF) was also significantly elevated.  During a follow up call, the patient indicated that the lesions have become smaller with the steroid treatment, but that they have not completely resolved.  

What do you think the patient is suffering from? What does the blood work indicate as a causal and/or correlative factor in this condition?  

Answer 1