A 22-year-old man is being evaluated for a 2-week history of multiple, severely pruritic, erythematous papules symmetrically distributed on the neck and beard region, shoulders, arms, mons pubis, axillae, and netlike arranged lesions on the lower back (Fig. 1A, 2A and 2B). The nails and oral mucosa were unaffected. The patient was afebrile, showed no systemic symptoms, and denied taking any medications. He had been on a strict diet for religious reasons avoiding any form of food and was drinking only water for the last few weeks.
Figure 1. By Regina Fink-Puches, MD; Teresa Deinlein, MD; Eva Narro-Bartenstein, MD; Elena Eber, MD; and Lorenzo Cerroni, MD
Figure 2. By Regina Fink-Puches, MD; Teresa Deinlein, MD; Eva Narro-Bartenstein, MD; Elena Eber, MD; and Lorenzo Cerroni, MD
What is the most likely diagnosis?
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A.
Dowling-Degos disease (DDD)
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B.
Prurigo pigmentosa (PP)
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C.
Confluent and reticulated papillomatosis of Gougerot and Carteaud (CRP)
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D.
Dermatitis herpetiformis Duhring (DHD)
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E.
Trichophytosis
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Footnotes
Funding: This article has no funding source.
Conflicts of interest: The authors have no conflicts of interest to declare.
IRB approval status: not applicable.