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"A wood carver with a rash"
Case preparation: Dr A Chong Images: Dr C Meehan

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A 51 year old man, who migrated from Thailand to Australia 12 months ago, presents with an 8 month history of a scaly, annular, erythematous eruption affecting mainly his axillae and neck. The eruption is scaly, not pruritic, and has gradually been spreading. It did not respond to short trials of topical antifungals and medium-strength topical steroids.

There is no history of serious medical illness apart from chronic bronchitis, however over the past few months he has lost 5 kg in weight, associated with loss of appetite, and he has also noticed frequent night sweats and worsening of his bronchitis.

He drinks 8 standard drinks a day and smokes 10-15 cigarettes daily. Current medications are rocithromycin and ventolin inhaler for bronchitis. He is allergic to sulpha drugs. His work as a sculptor involves carving, sanding and polishing exotic timbers.