What is the diagnosis for a patient with multiple skin lesions on the right side of the back, a new lesion over the liver, pruritus, and slight tenderness, with a history of daily alcohol (ethanol) use?

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Differential Diagnosis

  • Single most likely diagnosis
    • Alcoholic Dermatitis or Skin Lesions: Given the patient's history of daily alcohol use, it's possible that the skin lesions are related to alcohol-induced dermatitis or other skin conditions associated with alcoholism, such as psoriasis or seborrheic dermatitis. The location of the lesions on the back and the new sore over the liver area could be related to poor hygiene, malnutrition, or other factors associated with chronic alcohol use.
  • Other Likely diagnoses
    • Contact Dermatitis: The patient's report of itching and a slight sting when the sores are palpated could suggest contact dermatitis, possibly due to an allergic reaction to a substance that came into contact with the skin.
    • Insect Bites or Infestations: The presence of multiple sores on one side of the back could be indicative of insect bites or infestations, such as scabies or bed bugs.
    • Folliculitis: The patient's history of daily alcohol use and poor hygiene could contribute to the development of folliculitis, an inflammatory condition of the hair follicles.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Skin Cancer: Although less likely, it's essential to consider skin cancer, particularly given the patient's history of alcohol use, which may increase the risk of certain types of skin cancer.
    • Infectious Endocarditis: The new sore over the liver area could be a Janeway lesion, which is associated with infectious endocarditis, a potentially life-threatening condition.
    • Hepatic or Abdominal Abscess: The location of the new sore over the liver area could suggest an underlying hepatic or abdominal abscess, which would require prompt medical attention.
  • Rare diagnoses
    • Erythema Multiforme: A rare skin condition characterized by target-like lesions, which could be triggered by various factors, including infections or medications.
    • Sweet Syndrome: A rare condition characterized by fever, leukocytosis, and tender, erythematous skin lesions, which could be associated with underlying infections, inflammatory conditions, or malignancies.

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