UPP - Department of Dermatology, Dermatopathology Unit
S. Priya Sivanesan, MD, MPH, Alexandra Zhang, MD, and Jukic Drazen, MD
JANUARY 2009 WEB CASE OF THE MONTH
A 62 year old African American male presented to the clinic complaining of a “yearly rash� on his left leg from October to May each year for the last several years. Rash only appears on left lateral leg each October and resolves completely back to normal skin without any treatment. Patient reports that there is no residual hyperpigmentation or other skin changes after rash resolves. Patient describes a mild soreness of affected area with no pruritus. Patient has never sought medical treatment for this rash as rash always resolves each May. However, this year patient was more concerned as “blisters� developed within rash and skin became scaly. Patient denies any new medications or use of a heating pad. However, upon further questioning, patient states that his furnace has been broken for several years and he has been using a stove heater to warm his home. His chair is positioned closely to this stove heater and his left leg faces the heater. He denies fever, chills, nausea, vomiting, weight loss, or abdominal pain.
Pt has history of hypothyroidism well controlled with synthroid. In addition to synthroid he also takes Prilosec for occasional GERD. He is allergic to penicillin.
Physical exam reveals a reticulated pattern of violaceous plaques and some erythematous, indurated, scaly plaques limited to lateral surface of left leg from mid thigh to lower calf. There are also purpuric papules scattered within this reticulated network (Figures 1, 2 and 3). Area does not improve with warming. Right leg reveals normal skin with no abnormalities. Bilateral upper extremities and trunk also reveal normal skin with no lesions.
Biopsy revealed hyperkeratosis with acanthosis, slight squamous atypia, and papillary dermal endothelial hyperplasia. One focus of fibrinoid degeneration of a vessel was also seen. (Figure 4)
None obtained