Painful fissured plaque in a girl with Crohn's disease.

A 16-year-old Saudi girl diagnosed with Crohn’s disease (CD) when she was 10 years old, receiving infliximab (5 mg/kg IV) every 8 weeks for 2 years, presented with a painful cutaneous eruption in the posterior auricular region for the last 6 months. Examination found hyperkeratotic eroded fissured crusted erythematous plaque in the left posterior auricular area extending to the earlobe (Fig. 1A), progressively increasing over the last 6 months, associated with moderate to severe pain and mild pruritus. Dermatoscopic examination revealed uniform dotted vessels and a white-to-yellowish scale. There was no involvement of the scalp, oral and nasal mucosa, genitalia, or nails. Histopathological analyses (Fig. 1B) were performed. Special stains using Periodic acid-Schiff and Grocott methenamine silver revealed no organisms. However, tissue culture and swab for culture and sensitivity grew methicillin-susceptible Staphylococcus aureus. Basic laboratory panels, including complete blood count, liver and renal function tests, hepatitis B and C and HIV serology, purified protein derivative testing, and chest X-ray, were normal.