Author(s): Jason Mammino*, DO and Jere Mammino, DO, FAAD, FAOCD
A 47-year-old male was seen in a rural Nicaraguan community for difficulty shaving his beard. The patient stated his face changed roughly 10 years
ago and since has never looked the same. He presented at the clinic with an eczematous rash confined to the sun exposed surfaces on his skin. His face and posterior neck were covered in a confluent lichenified erythematous eruption sparing only the forehead and eyelids. The upper chest, forearms, and dorsal hands were hyperpigmented with various hypertrophic and hyperkeratotic lesions. The diagnosis of chronic actinic dermatitis was made due to the overall clinical picture along with limitations in further diagnostic capabilities. After initial therapy, the patient ecstatically returned to the clinic with greatly improved skin
