Case Number : Case 815 - 1st August Posted By: Guest

Nodular amyloidosis.

Chronically sun-damaged skin with a large and clefted homogeneous hyaline deposit widening a dermal papilla. I favor colloid milium of the adult until Congo red and PAS stains become available.

Discoid lupus erythematosus with secondary amyloidosis.

[size=2][i]I think there is something wrong with access to this case. It shows up on the right side in the SPOT DIAGNOSIS [b]Categories folder [/b](Main level) as the latest entry, but doesn't show up in the subfolder for [b]August 2013[/b].[/i][/size]

Hypertrophic DLE seems a reasonable consideration, given photo limitations, but would obviously need clinical context/history.

The features of prurigo nodularis, nodular solar elastosis, and tangential orientation complicate the interpretation. The hyaline changes in the papillary dermis seem accentuated by the tangential section, and may represent either thickened BM (going along the DLE / chronic interface dermatitis pathway), localized amyloidosis, or just fibrosis secondary to prurigo changes. The notched basal aspect of the keratinocytes, immediately adjacent solar elastosis, and the absence of melanophages inside the hyaline areas imply the latter (fibrosis) to me. There is postinflammatory hyperpigmentation and focal atrophy of epidermis.

DLE

Yes, I called it discoid lupus erythematosus as well. This went along with the clinical impression.

An oblique section played a trick on me.