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Image challenge: A case of dermatitis of uncommon origin

what caused a patient, whose medical history was only significant for a contact allergy to nickel, to develop a pruritic cutaneous lesion on her left lower abdomen?

Gastroenterology clinical image challenge: A 59-year-old woman presented with a three-month history of a pruritic cutaneous lesion in the left lower abdomen, with intermittent occurrence of local pain. She had no major medical problems and her medical history was only significant for a contact allergy to nickel. She had had a laparoscopic myomectomy and a laparoscopic appendectomy 13 and 12 years earlier, respectively. She reported having been treated with antifungal and corticosteroids creams during the last two months, without significant improvement. 

Physical examination was unremarkable, except for an eczematous-like area in the left lower abdomen with central hyperpigmentation and peripheral erythematous reaction (figure). No regional lymphadenopathy was present.

Plain radiography followed by a computed tomography scan of the abdomen suggested the diagnosis.

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.


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