Patient with treatment resistant peristomal and scalp dermatitis

Abstract

A 39-year-old male with history of cloacal exstrophy with colostomy and ileal conduit presented with a rash that started around his ostomy and on his scalp and spread to involve his gluteal cleft and groin gradually over 1 year. Physical examination revealed erythematous scaly papules coalescing into plaques with petechiae surrounding his ostomy and on his scalp (Figs 1 and 2). Previous biopsies from peristomal skin and scalp showed spongiotic and psoriasiform dermatitis, respectively, and he had failed topical steroids, fluconazole, dupilumab, and guselkumab.