Postpartum Limb Rash in Patient with Multiple Dermatological Conditions

Case at a Glance

A 34-year-old postpartum female with a history of psoriasis and PCOS presents with recurrent pruritic, inflammatory rash on extremities, initially appearing during pregnancy and recurring 6 months postpartum.

Patient's Story

The patient delivered her first child via cesarean section following a complicated pregnancy marked by severe hyperemesis gravidarum, significant weight loss, and placental insufficiency leading to intrauterine growth restriction. She has a medical history of polycystic ovary syndrome (PCOS), established psoriasis typically limited to feet and elbows, and inverse psoriasis under the breasts that developed one year prior to pregnancy. During pregnancy, she experienced worsening rosacea and developed a new rash on arms and legs resembling insect bites. Six months postpartum, a similar pruritic, inflammatory rash has recurred on her extremities.

Initial Assessment

Patient presents with multiple erythematous, raised lesions on bilateral arms and legs, described as intensely pruritic and inflammatory in appearance. The lesions have a nodular quality and are distributed primarily on the extremities. Additional involvement noted on scalp. Patient reports similar presentation during pregnancy that was never definitively diagnosed.

The Diagnostic Journey

Initial dermatological consultation during pregnancy suggested possible biopsy but was not pursued. Current presentation raises differential diagnoses including prurigo nodularis, atypical psoriasis presentation, or pregnancy-related dermatosis with postpartum persistence. The nodular, intensely pruritic nature of the lesions on extremities is characteristic of prurigo nodularis.

Final Diagnosis

Clinical suspicion for prurigo nodularis based on presentation of intensely pruritic nodular lesions primarily affecting extremities, with initial onset during pregnancy and postpartum recurrence.

Treatment Plan

Dermatological follow-up recommended for definitive diagnosis and management. Consideration for topical corticosteroids, antihistamines for symptomatic relief, and potential biopsy for histopathological confirmation. Patient education regarding chronic nature of condition and trigger avoidance.

Outcome and Follow-up

Patient seeking medical evaluation for persistent symptoms. Long-term management will depend on confirmed diagnosis and response to initial therapeutic interventions. Regular dermatological monitoring recommended given multiple concurrent skin conditions.