A 42 year old man came to see you in your office in New Orleans. He has a rash that has been progressing for about 5 weeks. It is itchy and new lesions are cropping up.

He does not remember eating any raw fish or other seafood.

On examination, his Blood pressure is 146/92, Temperature is 98.6, Pulse 88/minute. Scalp is normal, General examination is normal except lesions shown that are present all over his trunk and arms.

Which of the folowing statements is appropriate in this situation?

1.  Start patient on steroids and follow up in 2 weeks

2. Refer him to an Infectious disease specialist immediately.

3. Start him on Ciprofloxacin and follow up in 3-7 days.

4. Take blood cultures for a comma shaped bacteria

The answer is 1. The patient has lichen Planus.

Notice the violaceous hue to the rash. This is the typical rash of Lichen Planus. It itches really bad and treatments are targeted to reduce this. Treatment may decrease the duration of the illness. The typical treatments include Steroids - locally or systemically and antihistamines to reduce itching. One may also use calamine lotion to reduce itching. It is not an infectious disease but has been noticed at a higher rate in patients with Hepatitis C.  so one may add a test for Hepatitis C  to be completed before the 2 week follow up.

The other choices hint towards Vibrio vulnificus which is a fulminant disease and once the rash comes up in a patint of Vibrio, the patient is septic and crashing. It is covered elsewhere in the site.