How would you treat this scaly rash?

Case:
This rash on a 60-year-old man’s nose has worsened over the past few months.

What does this look like to you?

A. Seborrhea.
B. Rosacea.
C. Lupus erythematosus.
D. Sarcoidosis.
E. Contact dermatitis.

This patient had features of both seborrheic dermatitis, A (scaling) and rosacea, B (erythema, papules, and telangiectasia).

What treatment would you offer?

F. Sulfur/sulfacetamide cream.
G. Ketoconazole 2% cream.
H. Desonide cream.
I. Sulfacetamide lotion.

Answer:

Any combination of the topical treatment options can be effective.

Lupus would be tender and more indurated. Sarcoidosis can mimic most diseases; biopsy would be required if the patient did not respond to the topical therapies. Contact dermatitis would be more pruritic than the rash seen here, and the patient would typically have an exposure history.