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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1192 - 16th January Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F55. Medial buttock. Clinically lichen sclerosus.

Case posted by Dr Richard Carr


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Guest Romualdo

Posted

I would do a Warthin-Starry stain or immunostain for Borrelia. I think this is acrodermatitis chronica atrophicans, despite the location is unusual.

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I see some bacterial microorganisms into the cornea. Special stains are necessary and my hypothesis is Erythrasma. There´s a nonintertriginous form of Erythrasma called Disciform erythrasma that can simulate other disease like Lichen sclerosus. Wood´s lamp would also be of help.
http://www.ncbi.nlm.nih.gov/pubmed/6851651

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Dr. Mona Abdel-Halim

Posted

As Igor said, I am seeing structures in the stratum corneum that worth staining, mostly erythrasma..

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Dr. Richard Carr

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201192%20-%20RAC7023x40_Gram.png[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201192%20-%20RAC7023x40b_PAS.png[/img]

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Robledo F. Rocha

Posted

[left]I must confess that epidermal atrophy, telangiectatic vessels and homogenized collagen bundles in the upper dermis drew my attention and would make me favor a sclerodermoid disorder without special stains. Congratulations to my friend Igor, who first discerned those barely visible Gram-positive bacteria in the stratum corneum of HE-stained images.[/left]

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Guest Tiberiu Tebeica

Posted

I am back. HNY everybody! Lot easier with special stains. I agree with erythrasma.

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Dr. Richard Carr

Posted

There was another biopsy of the vulva done at the same time showing features of lichen sclerosus without erythrasma. I don't see how erythrasma could mimic the [u][b]histological[/b][/u] dermal changes of LS seen here. I reported this biopsy as follows:

"Compact hyperkeratosis containing innumerable beaded-filamentous bacteria in keeping with erythrasma. There are also typical superficial dermal changes of quiescent lichen sclerosus with only mild lymphocytic infiltrate."

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