Dermatitis, Diarrhea and Alopecia: What Is Your Diagnosis?

Nicole Huffman, MD

Disclosures

May 13, 2011

History and Clinical Presentation

A 36-year-old black woman presents to the emergency room with the chief complaint of a desquamating, painful skin rash around her mouth, abdomen, groin, inner thighs, and buttocks, which has been present for the past 8-10 days. She also noticed increased peeling of the skin on her hands and feet. The patient has not been able to eat normally for a few days because of increasing tongue pain.

History

Eight years ago she had gastric bypass surgery and has lost more than 230 lb. Since her surgery, she has suffered from chronic abdominal pain and diarrhea as a result of short gut syndrome, and she reports worsening of diarrhea for the past 4 months. The patient also complains of chronic, progressive hair loss.

Physical Examination

Physical exam reveals large, red-brown plaques with desquamating sheets of scale and underlying superficial erosions and denuded tissue on the patient's buttocks (Figures 1 and 2) and inner thighs (Figure 3). On oral exam, similar perioral, red-brown desquamation and smooth, edematous glossitis are seen (Figure 4). Desquamation is also evident on the palms of her hands (Figure 5) and soles of her feet. Diffuse, patchy, nonscarring alopecia is present on the scalp.

Figure 1. Red-brown plaques and desquamation of patient's buttocks.

Figure 2. Red-brown plaques and desquamation of patient's buttocks.

Figure 3. Plaques and desquamation of patient's upper thigh.

Figure 4. Perioral plaques and glossitis.

Figure 5. Palms of hands, showing skin desquamation.

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