Generalized XXXX without primary lesions. Differential diagnosis and approach to treatment.

@entity1 @entity4182 @entity11886 @entity1066 @entity2688 @entity5774 @entity111 @entity6914 @entity7287 @entity1011
A 65-year-old @entity1 presented with recurrent generalized @entity111 and excoriations of many years' duration. He had been treated with antihistamines, topical corticosteroids, and antibiotics for secondary wound infections, but improvement was only temporary. He had also been hospitalized for leg @entity1066 complicated by @entity2688 . Examination revealed multiple oval and linear red papules and nodules measuring 0.5 to 2 cm in diameter. Some of the lesions were eroded and had a central crater and yellowish crust. The @entity1 also had @entity4182 localized to the posterior scalp, neck, upper back, chest, abdomen, arms, and legs with sparing of the middle and lower back (figures 1 and 2). An @entity1066 measuring 1.5 x 2 cm that was surrounded by indurated skin was present on the medial aspect of his right ankle. The @entity1066 was partially covered by yellow exudate. There was no evidence of @entity2688 . Liver enzyme, serum @entity1011 , and @entity7287 levels, as well as a chest roentgenogram, were normal. Wound cultures for bacteria and fungi were nonsignificant. A punch biopsy from a representative lesion showed an abrupt epidermal defect with sparse superficial lymphocytic infiltrate in the dermis. The @entity1 was admitted to the hospital to isolate him from his home environment. He received a 10-day course of systemic cephalexin, topical @entity6914 ointment for the affected skin areas, and oral @entity5774 for @entity111 . Ultraviolet light therapy was instituted once daily and was to continue for 2 months. His lesions had improved moderately by the time he was discharged from the hospital. On follow-up 2 weeks later, his lesions were flat and had resulted in @entity4182 . Three months later, however, he had persistent, intense @entity111 , and new excoriations had developed on his forearms and back. He improved after receiving treatment with oral @entity11886 .
