Annular scaly erythematous plaque on the right chest

A woman in her 80s presented to dermatology with a three year history of a persisting, mildly pruritic, annular, infiltrated, erythematous plaque with crusts and scales on the right side of her chest (fig 1). She said this area was frequently exposed to the sun in the summer, when she would usually wear vests. Despite treatment with topical corticosteroids and antifungal ointment for various periods over the three years, the lesion persisted with only slight improvement. Microscopic examination of scales for fungi (potassium hydroxide test) was negative.bmj;379/dec08_2/e071572/F1F1f1Fig 1Annular, infiltrated, erythematous plaque with crusts and scales on the right side of the chest.QuestionsWhat is the most likely diagnosis?What are the differential diagnoses?What are the therapeutic options?Answers1.What is the most likely diagnosis?Bowen’s disease— suggested by the longstanding duration, poor response to topical steroids and antifungal ointment, and only mild pruritis (that is, different to classic eczema and tinea). It typically manifests as…
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