Leg rashes and unwell – 10 cases

Each of these patients is unwell and presented with a rash on their legs.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

Case 1

The first patient presented complaining of dry itchy skin on her lower legs that was not improving with a moisturiser. On examination, dry skin may be seen in association with eczema, i.e., asteatotic ecema (eczema craquele). Further inquiry determined that she was feeling tired and gaining weight despite poor appetite. The rash resolved with a mild topical steroid ointment and a thicker emollient. Thyroid function tests revealed elevated thyroid-stimulating hormone (TSH) level and free T4 just below the normal range, which was considered significant.

Asteatotic eczema or eczema craquelé

Asteatotic eczema is sometimes due to hypothyroism.

Cutaneous signs of hypothyroidism include dry, rough, cold and pale skin and generalised myxoedema; dry, brittle slow-growing hair and brittle slow-growing nails. It may also contribute to carotenaemia, eruptive and tuberous xanthomas.

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