UPP - Department of Dermatology, Dermatopathology Unit
Shery Varghese MD, PhD, Alexandra Zhang MD, Manuel Zarandona MD, Jonhan Ho MD
APRIL 2009 WEB CASE OF THE MONTH
 A 41 y/o African American male with no significant past medical history was seen in our clinic with a complaint of chronically lichenified, thickened skin on his bilateral upper extremities and chest (See figures 1 to 2). He reported that this had occurred after he had started his new job in a cleaning business. He used to clean ovens with “Mighty Mite Cleaner� and floors with “Wash and Walk Cleaner�. He used to mix the chemicals in buckets and wash the floors and ovens without gloves. Over the year that he was at this job he noticed that his upper arms and upper chest ,where he had contact with the chemicals, were “tightening� up to the point that he could no longer make a fist, or tie his own shoe laces. Before presentation to our clinic he had been unemployed for a year without noticeable improvement in his physical ability. He had no other systemic symptoms.
Patient has thickened, lichenified skin over upper extremities bilaterally and over upper chest. (see figures 1 to 2)
Laboratory studies
The patients BNP and CBC were within normal limits. His autoimmune markers ANA, anti-centromere, Scl-70, dsDNA, chromatin, RNP, anti-Sm, SSA, SSB, Jo-1, and ribosomal P were negative. The patient also had a normal chest x-ray.
The differential diagnosis for this patient included morphea vs eosinophilic fasciitis vs irritant contact dermatitis. A punch biopsy was done in order to differentiate between these possibilities.