Stocking pink

We see lots of skin problems in primary care. 

Most of them are common and pretty straight forward: poison ivy, bug bites, pityriasis roseatinea versicolor, seborrhea, eczema, contact dermatitis. Some of them are easy to diagnose but hard to treat: psoriasis and lichen planus. Some are even potentially lethal: melanoma and cutaneous lymphoma. Whether serious or benign, however, skin conditions almost always bother patients a great deal. On occasion, however, they are simply amusing.

She had called on the 6th of July, very distressed by a rash she had first noticed the day before. She described it to the receptionist as really weird, ‘kind of like pink lace’ and said it was tender and limited to her lower legs. I had to confess, it was a rash unlike any I had seen: reticular, pink, slightly warm, and tender when I pressed it with a finger to see if it blanched with pressure (it did). It began at the ankles, sparing the feet, and faded about an inch above the knees. She said it burned.

The diagnosis was pretty clear from across the room, but I proceeded with my litany of rash questions, stalling while wondering to myself how to explain this to her.

Her only medication was the birth control pill she had been taking for three years. She had no known allergies or previous skin problems. No, she had never had a rash like this before. No one else at home or at work had a similar rash. She had no pets. She had not used any new laundry or skin care products. And she knew it was new yesterday, because the day before she had been at Old Orchard Beach with her boyfriend to celebrate the Fourth.

Finally, out of questions and running out of time, I commented that it looked familiar and asked her if it reminded her of anything.

“Yes,” she said. “It looks just like the fishnet tights I wore to the beach on…”  Her voice trailed off and she looked down at the floor between us. “Oh. What a funny sunburn.” I suggested cool compresses, ibuprofen or acetaminophen for discomfort, and avoiding sun exposure until it had healed. She was in a hurry to leave and I’m not sure she heard me.

 

It’s only obvious when you have figured it out.

 


 

 

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