Over the past 10 years, this now 52-year-old woman has seen several different primary care providers for evaluation of a rash on her leg. The latest, after labeling the problem a resistant fungal infection, refers her to dermatology.

During her decade-long odyssey, the patient has been prescribed innumerable topical and oral medications, including corticosteroid creams, foams, and ointments and antibacterial creams (eg, triple-antibiotic cream and mupirocin). She also has taken several courses of oral prednisone, which helped for the duration of treatment; alas, upon cessation, the rash would promptly reappear. Modest relief from itching was achieved with some of the products tried--particularly, the topical steroids.

The pink, scaly rash covers most of the medial aspect of her left foot and calf. On the latter is a round, scaly, well-defined plaque. A similar rash covers the rim of her right foot but does not extend upward onto the calf. No other rashes or skin abnormalities are noted.

The patient's overall health has been reasonably good, considering her history of smoking (30+ pack-years) that led to early COPD. She lives with her husband and her elderly mother; there are no pets or children in the household.