[50M] With positional rash and chronic scalp condition

Patient Description

A 50-year-old male presents with a non-itchy, blanching rash on the trunk and legs that appears after standing up for a few minutes and disappears upon lying down or elevating the legs. This has been occurring for approximately one year. The patient also reports a long-standing issue with greasy skin on the face, chest, and shoulders, as well as pus-filled, crusted bumps on the scalp accompanied by dandruff, which has been a persistent issue for years. The scalp condition is exacerbated by sweating and previously by wearing hats. Additionally, the patient has red and purple blotches on the stomach skin. The patient has a history of pollen allergies and sinusitis, for which he takes Allegra and Pepcid. There are no known drug allergies, and no other medications are reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Orthostatic Purpura: This is a condition where blood vessels in the skin break when a person stands up, causing a rash or red blotches that disappear when lying down or elevating the legs. This condition is more common in older adults and those with high blood pressure, but it can occur in anyone.

    • There isn't a specific treatment for orthostatic purpura, but managing blood pressure and avoiding standing for long periods can help.
  • Seborrheic Dermatitis: This is a common skin condition that mainly affects the scalp, causing scaly patches, red skin, and stubborn dandruff. It can also affect oily areas of the body, such as the face, sides of the nose, eyebrows, ears, eyelids, and chest.

    • Treatment typically involves medicated shampoos, creams, and lotions.
  • Scalp Folliculitis: This is an inflammation or infection of the hair follicles on the scalp causing pus-filled bumps. It can be caused by bacterial infection, fungal infection, or an inflammatory condition.

    • Treatment usually involves antibiotics or antifungal medications.

Please remember that these are only possible explanations for your symptoms. It's important to consult a healthcare provider for an accurate diagnosis and treatment.

What you can do

  1. Try to avoid standing for long periods to see if this reduces the appearance of the rash.
  2. Use medicated shampoos designed for dandruff and oily skin.
  3. Keep the skin clean and dry to prevent infections.
  4. Consult a healthcare provider for a proper diagnosis and treatment.

What you should look out for

If you notice any of the following symptoms, please seek medical attention immediately:

  • If the rash becomes painful or starts to spread rapidly.
  • If you develop a fever or other signs of infection, such as increased redness, swelling, or pus.
  • If you experience sudden or severe pain.
  • If the symptoms persist or worsen despite home care.

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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11 mo ago

People Also Ask


What causes a rash that appears when standing and disappears when lying down?

A rash that appears when standing and disappears when lying down could be due to orthostatic purpura, where blood vessels in the skin break when standing. This condition is often related to blood pressure changes and can be managed by avoiding prolonged standing.


How can seborrheic dermatitis be managed effectively?

Seborrheic dermatitis can be managed with medicated shampoos, creams, and lotions that contain ingredients like ketoconazole, selenium sulfide, or zinc pyrithione. Regular cleansing and moisturizing can also help control symptoms.


What are the common treatments for scalp folliculitis?

Scalp folliculitis is typically treated with topical or oral antibiotics if it's bacterial, or antifungal medications if it's fungal. Keeping the scalp clean and avoiding irritants can also help manage the condition.


Can pollen allergies and sinusitis affect skin conditions?

Pollen allergies and sinusitis generally do not directly affect skin conditions, but they can exacerbate symptoms if the immune system is already compromised. Managing allergies with antihistamines and avoiding triggers can help reduce overall inflammation.


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