U038 - Cases from the Cornfields: Pearls from the Midwest!

In this presentation, Brian Swick, a dermatology specialist, discusses a case involving a 39-year-old man with a long-standing asymptomatic eruption on his trunk, previously diagnosed and treated for various dermatological conditions, including acne and inflammatory dermatosis. Despite various treatments, the lesions—characterized by papules, pustules, and hypopigmented scaly patches—persisted. Swick evaluated the condition through clinical examination and biopsies, leading to considerations of differential diagnoses like Grover's disease, Malassezia folliculitis, and a potential variant of seborrheic dermatitis, especially due to the observed follicular involvement and lack of pruritus. After exploring prior literature that highlighted similar presentations, Swick hypothesized that this case might represent an unusual form of follicular variant of seborrheic dermatitis and possibly Malassezia folliculitis based on the histological findings. He shared his treatment approach, beginning with topical ketoconazole and escalating to systemic fluconazole, ultimately resulting in clearance of lesions, although long-term follow-up was limited. Throughout, he acknowledged the challenges in diagnosing and treating cases like this due to overlapping clinical features and the often recurrent nature of such skin conditions, inviting insights on treatment strategies from the audience.