Prepared by Arun Kumar Solipuram, MD, Geriatric Fellow, Pam Cacchione, PhD, Consuelo H. Wilkins, MD, CMD, Assistant Professor of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Mo

A 90-year-old nursing home resident with Alzheimer’s dementia was found to have extensive rashes on the soles of her feet (Figure) and a few papular lesions on her palms. She denied itching or pain. She had no other systemic signs or symptoms and no other lesions. Her medical history included a positive rapid plasma reagin (RPR) test done 9 months ago.

What’s Your Diagnosis?
Syphilitic lesions

Pustular psoriasis

Chronic eczema

Dermatitis herpetiformis