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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 1479 -24 February 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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Case History: 36 year-old male with scaly red patches. This biopsy is from the right chest.

Case posted by Dr Hafeez Diwan


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I am between PR Gilbert x Guttate Psoriasis. Because of the extensive hypogranulosis and the diffuse, rather than mound parakeratosis, I think this is Guttate Psoriasis.

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Raul Perret

Posted

Pityriasis rosea. PTC also crossed my mind as a differential but it fits better with the first one. I think there is a nice teapot lid sign  

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vincenzo polizzi

Posted

I favor pityriasis rosea. Too spongiotic and with some extravasated red cells. A discrete parakeratosis. No neutrophilic exocytosis.

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Raul Perret

Posted

I dont know what is your opinion but as an intern I think I saw a lot of overdiagnosis of psoriasis (even by experienced dermatopathologists). I usually try to find dilated tortous papillary capillaries (That apparently Ackerman stated was the most important feature) or neutrophils in the stratum corneum (Weedon states is the single most important feature); if I dont see one or both of these I try to avoid the diagnosis of psoriasis. 

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I agree with you. My concern is that guttate psoriasis can be similar to PRG clinically and that there´s no typical expected findings usually on these lesions according to textbooks.

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Nitin Khirwadkar

Posted

Spongiotic and psoriasiform tissue reaction pattern, with angulated tier of parakeratosis, some red cell extravasation within the papillary dermis. Would favour pityriasis rosea (over a drug reaction).

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I would like to read the opinion of the collegues.

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Dr. Mona Abdel-Halim

Posted

Favour Rosea also. Too spongiotic, no dilated tortous capillaries, no neutrophils in the stratum corneum. Sometimes it is very difficult to be 100% sure on pathological basis only whether it is rosea or guttate psoriasis. Clinical correlation is important in such cases. Pit rosea has characteristic pityriasiform collarette of scales. Psoriatic scales are different. Some cases of rosea present with papules not patches/plaques, still one can clinically see the collarette of scales in some lesions and the distribution is usually parallel to the ribs. So to conclude, if I did not find enough support of psoriasis (dilated tortous capillaries/ neutrophils in stratum corneum) I favour rosea over guttate psoriasis and ask for clinical correlation. We are lucky in our department in that we- as dermatopathologists from a dermatology back ground- do see the controversial cases by ourselves !!! So such cases are easily settled.

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Guest Romualdo

Posted

If the term "patches" was used to describe the lesions maybe this a look-alike of pityriasis rosea, erythema annulare centrifugum.

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