UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Jason G. Whalen, MD; Joseph C. English III, MD; Leena Lourdaraj, MD; Drazen M. Jukic, MD
FEBRUARY 2005 CASE OF THE MONTH
CLINICAL FINDINGS
D. J. was a 51 year-old African-American female who presented with a rash on her neck, chest and arms. They first appeared approximately 5 months prior to her visit, and were only minimally pruritic on occasion. She described the lesions as "blue circles that have progressively become darker." There was no rash prior to the one she presented with. Triamcinolone ointment and hydroxyzine tablets were given to her by her primary physician with minimal/no improvement. She has not started any new medications in greater than 3 years. She did admit that she is of partial Latin-American heritage.
D.J.'s past medical history included Gastroesophageal Reflux Disease (GERD) and Omeprazole was her only medication. She had no known allergies. No other family members experienced similar rashes. She was a non-smoker and non-drinker. Review of systems was negative .
Physical Exam
On exam, there were multiple symmetric bluish-black macules and patches scattered on her neck, upper chest and upper arms (Figures 1, 2, 3). They were oval and circular in shape, and some had irregular borders.
Histopathology
A 4 mm punch biopsy was obtained from the paracentral region of a lesion on the left upper arm. Acanthosis/Papillary hyperplasia of the epidermis as well as focal vacuolar change at the epidermal-dermal junction was noted (Figures 4, 5). In addition, multiple foci of dermal melanophages were observed (Figures 5, 6).
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