UPMC
Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
5230 Centre Avenue
(412) 864-3860
Pittsburgh,
PA
15213 (412) 864-3890 FAX
Oliver A Perez MD, John McSorley MD, Greg Ausmus MD, Arash Radfar MD, Drazen Jukic MD, PhD
MARCH 2009 WEB CASE OF THE MONTH
CLINICAL FINDINGS
Clinical History
A 73 y.o. black female with more than ten year h/o plaques with subsequent scarring on bilateral dorsal hands. The patient had been treated with topical and intralesional glucocorticoids, topical retinoids, other systemic immunosuppressants, and photochemotherapy. She did not have h/o hepatitis C infection. The patient did not report any symptoms at final presentation.
Physical Exam
Bil dorsal hands had brown to violaceous, annular plaques with central atrophy and raised borders. There was no oral, genital, nail, hair, or other cutaneous involvement. (see figures 1 to 4).
Differential Diagnosis
Previous clinical differential diagnosis included LP vs. chronic actinic dermatitis vs. contact allergic dermatitis vs. elastolytic GA vs. porokeratosis vs. CTCL vs. DLE.
Histopathology
The biopsy was consistent with compact orthokeratosis, thinning of the epidermis, basilar vacuolar degeneration with occasional necrotic keratinocytes, intra- and sub-epidermal split, lichenoid lymphoplasmacytic infiltrate, and papillary dermal fibrosis (see figures 5 to 7). Â Neither fungal microorganisms nor basement membrane changes were seen with interpretation of PAS histochemical stain. Colloidal iron stain did not show any significant increase in dermal mucin. VVG stain highlighted a decrease in elastic fibers in the central, fibrotic area (see figure 8). Â These changes were not entirely specific, but the differential diagnosis included atrophic lichen planus or fixed drug eruption.
Dermatopathology Homepage