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What caused this highly pruritic rash that resists OTC remedies?

What caused this highly pruritic rash that resists OTC remedies?

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(Answer on next page.)

Case 1:
After 6 weeks of scratching a very itchy, worsening rash on his left leg, a 53-year-old man seeks medical evaluation. He has tried over-the-counter (OTC) topical remedies with no success. The patient is otherwise healthy and takes no medications.

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