Persistent Neck Rash for Over 15 Years: Diagnosing a Complex Dermatologic Case in a 42-Year-Old Male
By: Dr. Caroline Vaughn
At Village Dermatology in Katy and Houston, we understand that chronic skin conditions can deeply impact quality of life. Today, we're sharing the story of a 42-year-old male patient who presented with a long-standing rash on his neck—an issue he has battled for over 15 years without relief.
Patient Background
This patient arrived as a new consult, seeking answers for an itchy, persistent rash localized on the right inferior posterior neck and extending to parts of the upper back and trunk. He had previously consulted multiple providers and been prescribed topical and oral steroids, with minimal to no improvement. The prolonged nature of his symptoms and failure to respond to prior treatment made this a particularly challenging dermatologic case.
He expressed frustration with the lack of clarity surrounding his diagnosis and proactively requested a biopsy to identify the exact cause before pursuing additional treatments.
Clinical Examination
A focused dermatologic examination was performed, including the:
Neck and trunk
Face, eyelids, and lips
Although a full body skin check was offered, the patient declined. The skin revealed chronic patches on the mid posterior neck and upper back with characteristics that suggested several possible conditions.
Using dermatoscopy, we noted the rash had a nonspecific appearance, raising a differential diagnosis of:
Chronic Dermatitis (L30.9)
Lichen Simplex Chronicus (LSC)
Macular Amyloidosis
Next Steps: Punch Biopsy and Counseling
Given the chronicity and diagnostic uncertainty, a 4mm punch biopsy was performed on the mid posterior neck to obtain a tissue sample for histological examination. The area was numbed using local anesthesia and closed with 4-0 Nylon sutures.
During this visit, the patient received detailed counseling:
Moisturizers and emollients were recommended for skin hydration
We discussed phototherapy as a non-steroidal option pending biopsy results
He deferred further steroid use until a definitive diagnosis is made
What This Case Highlights
This case is a perfect example of how long-term, unresolved rashes require a stepwise and evidence-based approach. Biopsy is a critical tool when first-line treatments fail or diagnosis is unclear. Conditions like macular amyloidosis or lichen simplex chronicus may appear similar clinically but differ significantly in treatment strategies.
At Village Dermatology, we provide thorough evaluations for patients across Katy and Houston, ensuring that even long-standing skin concerns are met with clarity and compassion.
