Papular eruption in an adolescent with a mood disorder

Abstract

C A SE PRESENTATION A 14yearold girl with depression, anxiety, and attentiondeficit/ hyperactivity disorder presented with a progressive cutaneous eruption for 6 months. The rash initially appeared on the neck and subsequently spread to the upper chest, arms, and feet. The lesions were intermittently pruritic and had not responded to triamcinolone 0.5% cream. She also had a several year history of fingernail changes. She was otherwise healthy and had no new medication exposures. Her maternal grandfather had a longstanding history of a similar appearing rash and a diagnosis of bipolar disorder. The patient s mother had a history of unspecified rash in the past and nail changes, as well as diagnoses of bipolar disorder and depression. Physical examination revealed many 12 mm yellowbrown papules scattered primarily over the lateral and anterior neck (Figure 1), upper chest, bilateral upper arms, and bilateral antecubital fossae, and more sparsely scattered on the thighs and dorsal feet. Several fingernails showed white and red longitudinal bands and distal Vshaped notching (Figure 2). No oral lesions were noted on examination. Two shave biopsies were obtained, one from the left chest and one from the right forearm (Figures 3 and 4).