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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 1327 - 24 July 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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M40. Lesion on arm. Keeps picking. Case c/o Dr Nick Tiffin

Case posted by Dr Richard Carr


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Dr. Mona Abdel-Halim

Posted

From the clinical, it appears to be a solitary lesion. I am thinking of cutaneous focal mucinosis.

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Guest Romualdo

Posted

Excuse my ignorance, what does "keeps picking " mean?

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Eman El-Nabarawy

Posted

I can see focal parakeratosis, melanophages (? epidermal insult) plus the history of repeated picking! Could it be secondary cutaneous mucinosis to chronic dermatitis?
http://www.ncbi.nlm.nih.gov/pubmed/25834351

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Dr. Richard Carr

Posted

The oxford popular (pocket) dictionary
Pick: use a pointed intstrument or the fingers or beak etc. to make (a hole) in or remove bits from (a thing): detach (flower or fruit) from the plant bearing it; select, [i]n. [/i]picking; selection; best part.

Thanks Eman

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Dr. Mona Abdel-Halim

Posted

Nice article provided by Eman. However, it seems to describe peri-adnexal mucin in association with chronic eczematous dermatitis, in which there is peri-adnexal mucin accumulation. I think we are having a more extensive mucin deposition and also a stellatte fibroblastic component in this lesion making it fit more with the description of cutaneous focal mucinosis. I have read that cutaneous focal mucinosis can develop secondary to trauma. May be the patient is used to the habit of picking in his arm with the subsequent development of cutaneous focal mucinosis.

https://www.karger.com/Article/FullText/358249

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Dr. Richard Carr

Posted

Yes very good responses. Dr Nick Tiffin kindly gave me this case as cutaneous focal mucinosis. I don't know if the picking was incidental but thanks for the discussion. There does not seem to be very striking lichenification or nodular prurigo here.

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Guest Romualdo

Posted

Agree with trauma induced cutaneous focal mucinosis.

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