Persistent Rash on Arms and Legs – Case Report from Village Dermatology in Katy & Houston, Texas
by: Caroline Vaughn
At Village Dermatology, we often see patients with rashes that don’t respond to initial treatment. This case features a 53-year-old woman who presented with a months-long itchy, red rash affecting her arms and legs. Careful evaluation and a targeted treatment plan are key to helping such patients achieve relief.
Patient Background
The patient, new to our clinic, reported a moderately severe itchy and red rash that had been present for approximately three months. She had previously seen her primary care physician, who prescribed one round of cephalexin and two courses of prednisone, but saw no improvement.
Clinical Examination
A focused skin exam of the right forearm, left forearm, right lower leg, and left lower leg revealed follicular erythematous papules on the lower legs. The patient was otherwise healthy, alert, and in no acute distress.
Assessment & Differential Diagnosis
The appearance and history of the rash suggested several possible causes:
Keratosis Pilaris – a common skin condition causing rough, small bumps.
Irritant Contact Dermatitis – rash due to repeated exposure to an irritating substance.
Dermatitis, Unspecified – broader category when the cause is unclear.
Treatment Plan
To target both inflammation and dryness, we prescribed:
Derma-Smoothe/FS Body Oil – apply to affected areas twice daily for 2 weeks.
Recommended AmLactin lotion or CeraVe moisturizing cream for ongoing hydration.
Advised avoiding scrubbing or exfoliating the rash to prevent further irritation.
Suggested over-the-counter antihistamines for itching and gentle, non-irritating cleansers.
The patient was counseled on the proper use of topical steroids, including risks of skin thinning, hypopigmentation, and telangiectasias, as well as the importance of avoiding high-potency steroids on the face, groin, or skin folds.
Additional Findings – Benign Nevi
During the visit, the patient also mentioned a mole on her right breast. Examination revealed a 0.5 cm x 0.6 cm regular, symmetrical, evenly pigmented nevus on the left medial breast (10–11:00 position). This lesion appeared benign.
We advised monthly self-skin checks, continued use of SPF 30+ broad-spectrum sunscreen, and monitoring for changes in size, shape, color, or symptoms such as itching or bleeding.
Follow-Up
The patient will return in three weeks for reassessment of her rash. If symptoms persist, further diagnostic testing or a modified treatment plan will be considered.
Key Takeaway for Patients in Katy & Houston, Texas
If a rash persists despite antibiotics or steroids, it may require a different approach, including moisturizers, gentle skin care, and targeted anti-inflammatory treatment. At Village Dermatology, we specialize in evaluating stubborn rashes and developing effective, personalized treatment plans.
