Jennifer, 68, presents with a small itchy patch of scaly redness on the left lateral breast.

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<p>Jennifer, 68, presents with a small itchy patch of scaly redness on the left lateral breast (pictured).</p><p>It has been present for years and she has intermittently used topical steroids prescribed by various doctors. It does tend to improve with this treatment, but never completely, and it recurs when the steroid is ceased.</p><p>Her medical history includes anxiety, chronic insomnia and osteoporosis for which she takes doxepin, lemborexant, periciazine and risedronate. None of these medications are new or coincide with development of the rash.</p><p>She has not changed any skincare or wash products and has no dermatological history of note.</p><p>Biopsy is performed which shows a moderate dermal infiltrate of lymphocytes, spongiosis and lymphocytic exocystosis into the epidermis. The lymphocytes are almost all T-cells, predominantly staining for CD3.</p>

Dr Ryan Holmes is a GP in Bondi Junction, Sydney, NSW.