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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 1526 - 29 April 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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Spot Diagnosis provided by Dr Richard Carr


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vincenzo polizzi

Posted

Claw-like downgrowths of the rete ridges are present at the margins of the infiltrate but sincerly i thought of lichen striatus However there isnt any perieccrine infiltrate. So i agree with Raul and Nitin. LICHEN NITIDUS.

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vincenzo polizzi

Posted

Yes! There are giant cells also. I didn't see this with smartPhone..

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Yes, there is a focal lichenoid infiltrate, but I can see some infiltrate extending to intermediate and deep vessels and adnexial ducts as well. Without clinical information I prefer a diagnosis of Lichen striatus.

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Arti Bakshi

Posted

First thought was lichen nitidus too. But Igor has a valid point about the infiltrate extending deeper around adnexal structures in very 'lichen striatus' type patten. Difficult...but overall, I think the superficial dermal/epidermal pattern is so distinctive for lichen nitidus, that this would take precedence, hence favour lichen nitidus!

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Dr. Richard Carr

Posted

Nice discussion and I am glad I did not give the history which was as follows:

Widespread rash, tiny 1mm papules, slightly vioilaceous, itchy. DDx: Lichen nitidus, LP, eczema.

 

My report: Papular, focally granulomatous, papillary dermal inflammatory reaction in keeping with lichen nitidus.

 

I remember Phillip McKee saying something to the effect that if you have a cat with one leg missing it is still a cat.  I would add if a cat is wearing a hat it is still a cat!  Of course clinical correlation is essential for most inflammatory cases but this does look fairly typical of lichen nitidus as a most likely first diagnosis but fully agree to consider lichen striatus in a different clinical context.

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