UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: Maria F. Rueda, MD ,   Douglas Kress, MD,  Drazen M. Jukic, MD,PhD,
DECEMBER 2003 CASE OF THE MONTH
CLINICAL FINDINGSCLINICAL HISTORY:
A 24-year-old white male with past medical history of eczema and asthma, presented to the outpatient clinic with a pruritic, slowly enlarging, plaque on the left forearm.) The lesion first appeared 5 months before and did not improve with topical over the counter antipruritic medications. No involvement of any other body area was found.
The review of systems was only positive for localized pruritus on the left forearm. He denied any fever, chills, night sweats, weight loss, adenopathy or masses. The patient had not used asthma or eczema medications in many years.
On physical examination , the patient was a healthy looking male with a well-circumscribed 4x4cm plaque located on the left forearm. Close examination of the plaque revealed minute, coalescing, follicular, light yellow, shiny, papules and excoriations on the area (Fig 1). No lymphadenopathy was found. Additionally the patient exhibits follicular hyperkeratotic eyrthematous papules on both upper lateral arms in the fashion of Keratosis Pilaris. No other atopic stigmata were found.
The pathology report revealed inter and intracellular edema of the follicular cells, superficial and deep perivascular, predominant lymphocytic infiltrate with numerous eosinophils and focal parakeratosis with scale crust a top of a follicular opening. In several cuts, one observes an increase in the interfollicular mucin as well as some perifollicular mucin (Fig 2 and 3) (confirmed by colloidal iron stain, Fig 4). The PAS-D stain reveals no microorganisms.
In the 2-week follow-up visit the patient reported significant improvement of the pruritus and the lesion was clearly decreasing in size. Complete clearing of the lesion was achieved with 2 weeks more of Triamcinolone 0.1% ointment once a day
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