Which is the most likely diagnosis?

During the month of December, a middle-aged patient with chronically dry skin develops widespread coin-shaped lesions. The lesions begin as itchy patches of vesicles and papules. These later ooze serum and crust over. The lesions are most numerous on the extensor surfaces of the extremities and on the buttocks. The patient says that some of the lesions have appeared to heal and then reappear at the same sites. Which is the most likely diagnosis?
Answers:
The patient most likely has nummular dermatitis, which is a chronic inflammation of the skin, the etiology of which is still unknown. The presentation illustrated in the question stem is typical. This condition should be in your differential diagnosis whenever the terms "coin-shaped" or "discoid" are used to describe a patient's skin lesions in a question. Microscopically, the dominant feature is a localized spongiosis (corresponding to edema) of the epidermis, which may also contain minute fluid-filled holes that correspond to the tiny vesicles seen clinically in early lesions. Treatment of these patients is problematic, and numerous regimens involving corticosteroids or antibiotics have been recommended, each of which appears to work with some but not all patients.

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Bed sores.

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Shingles or she's too cold?Skin is drying from not enough heat.

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sounds like psoriasis. Perscribe her some dovonex ointment.

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Numular eczema.

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