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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 1918 - 05 Oct - Dr Richard Carr 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. Groin. ?Tinea, contact dermatitis, psoriasis. Case c/o Dr Philip Shapiro.


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Anil Patki

Posted

Epidermotropism with lymphocytes in epidermis larger than those in the dermis; thin wiry collagen fibres in papillary dermis point towards MF

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vincenzo polizzi

Posted

Granular parakeratosis. And a clear cell pagetoid  diskeratosis as incidental finding. 

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Anil Patki

Posted

Oh, the newbie (to borrow Dr Carr's term) in me thought that they are haloed lymphocytes!

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Dr. Mona Abdel-Halim

Posted

I think the clear cells are artefactual. To me, there is prominent SG yes but no PK to say granular PK. I think some structures are seen in the SC, would love to see Gram, PAS stains if available as I am thinking this could be erythrasma.

 

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Nitin Khirwadkar

Posted

Agree with the comments made by Mona. Not granular PK.

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Anil Patki

Posted

Clinically, erythrasma does not look like psoriasis or contact dermatitis because it's flattish and has a typical colour. It's easily diagnosed by examining it with Wood's lamp and responds readily to antibiotics. There is hardly any need to biopsy the lesion. Yes, it could be dermatophytosis rather than erythrasma.

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Dr. Richard Carr

Posted

Thanks for all the comments. This is erythrasma with rather spectacular and in areas quite confluent artefactual perinuclear clearing of the keratinocytes. In so-called pagetoid dyskeratosis, (which is not dyskeratotic) a similar phenomenon (of perinuclear vacuolisation) usually occurs in focal cells scattered in the keratinocytes in the upper layers and is often seen in ano-genital, groin & axilla, skin tags in particular, as an incidental phenomenon. The cells in the latter situation also appear larger than the surrounding keratinocytes with cytoplasmic pallor/bubbly  appearances so it does looks somewhat different to the artefact we are seeing here but may be this is a variation on that phenomenon. Agreed a competent clinician won't  biopsy a clear cut clinical case of erythrasma - it is rarely the suggested diagnosis when we occasionally see cases. Often erythrasma is seen as an incidental finding.

Hopefully Philip Shapiro will supply us with Gram or PAS in due course.

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