A 43-year-old woman is evaluated for painful wheals on the upper legs and back that have been present for 2 weeks. Individual lesions resolve with bruising in 3 to 4 days. The patient also reports some associated joint pain, particularly in the small joints of her hands. Her medical history is unremarkable, and she takes no medications.

On physical examination, vital signs are normal. There are polycyclic edematous plaques on the back and upper legs. The remainder of the examination, including joint examination, is normal.

Which of the following is the most appropriate management?

1) Epicutaneous patch testing
2) Ice cube provocation test
3) Oral prednisone
4) Skin biopsies
5) Topical triamcinolone

For a woman with joint pain and persistent plaques with bruising, systemic treatment with oral prednisone may help alleviate inflammation and symptoms, although further diagnostic procedures like skin biopsies may be considered if necessary.

Explanation:

In the scenario where a 43-year-old woman presents with polycyclic edematous plaques that resolve with bruising and is experiencing joint pain, the most appropriate management could likely be initiating systemic therapy with oral prednisone.

Given the absence of a notable medical history and the absence of current medication use, as well as the presence of systemic symptoms like joint pain, a short course of systemic corticosteroids may help reduce inflammation and alleviate symptoms.

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