Persistent Rash Case Report: Evaluating Dermatitis and Folliculitis in a 45-Year-Old Male
Rashes can be challenging to diagnose when symptoms overlap between inflammatory and infectious skin conditions. At Village Dermatology, we take a comprehensive, stepwise approach to evaluate persistent rashes and tailor treatment plans for optimal outcomes. This case highlights the importance of reassessment, diagnostic testing, and targeted therapy for unresolved skin lesions in Katy and Houston, Texas.
Patient Presentation
A 45-year-old male, an established patient, presented for evaluation of two separate rashes:
Hands: Flaking, itchy rash of moderate severity. The patient had been using Protopic® (tacrolimus).
Trunk (right lateral abdomen): Red, painful lesions associated with burning sensation and intermittent drainage, present since late December 2025. He had completed a 5-day course of Augmentin® and mupirocin ointment, noting partial improvement but persistent lesions.
The patient returned for further evaluation due to incomplete resolution.
Clinical Examination
A focused examination was performed, including the right and left lower extremities. The patient appeared well-developed, well-nourished, alert, and in no acute distress.
On examination, lesions on the right lateral abdomen were consistent with inflammatory and possibly infectious changes, raising concern for:
Dermatitis, unspecified
Folliculitis
Healing ruptured abscess
Assessment
Lesions on the right lateral abdomen
Differential diagnosis: dermatitis vs. folliculitis vs. healing ruptured abscess
Diagnostic Evaluation
Given the persistence of symptoms and drainage, a wound culture was obtained to help guide further management and rule out ongoing infection.
Treatment Plan
To address both inflammatory and potential infectious components, the following treatment plan was initiated:
Doxycycline 100 mg orally twice daily for 10 days
Clindamycin 1% topical gel, applied to affected areas twice daily until improvement
Recommend benzoyl peroxide (BPO) wash or continuation of chlorhexidine wash daily to affected areas
Continue use of emollients and gentle skin care products
Patient Counseling & Education
Extensive counseling was provided, including:
Skin Care
Use gentle cleansers and moisturizers regularly
Avoid harsh or fragranced products
Expectations
The patient was informed that a definitive diagnosis is not always immediate
Empiric therapy and follow-up are sometimes necessary to fully resolve complex rashes
Medication Counseling
Risks of prolonged topical steroid use, including skin thinning, pigment changes, and visible blood vessels
Importance of avoiding high-potency steroids on the face, groin, and skin folds
When to Contact the Office
Development of fever
Rapid worsening of the rash
Increased pain or drainage
All questions were addressed, and the patient demonstrated understanding of the treatment plan.
Follow-Up
Return visit scheduled in 2 weeks for reassessment and review of culture results
Expert Rash & Dermatitis Care in Katy & Houston
This case illustrates the importance of reassessment and diagnostic evaluation when rashes persist despite initial treatment. At Village Dermatology, we provide comprehensive care for complex skin conditions using evidence-based therapies and personalized treatment plans.
If you’re dealing with a persistent or painful rash, our dermatology team is here to help.
