Case Number : Case 1912 - 27 Sept - Dr Richard Carr Posted By: Guest

First thought : Lichen striatus.

May be this is a long standing lesion ( 18 month ) so the interfacie active component is relatively regressed.

But now, on my computer, I want to change the LS spot. Realizing the deep dermal inflammation is vasculitis (lymphocytic vasculitis), not perieccrine infiltrate.

So this could be a chilblain lupus. Frank ymphocytic vasculitis is usually more evident in CL than in idiopatic chilblain.

Like Vincenzo I thought of  "lymphocytic vasculitis" but I was thinking it could be one of the PPDs like Schamberg's disease which is occasionally seen in children.

Like your comment Raul. PPD is a good (and maybe the correct one) differential.

I was just thinking of chilblain lupus based on deep sited infiltrate and obvious vascular damage. But realizing that 12/18 months are more in keeping with PPD.

Pigmented Purpuric Dermatoses, likely Lichen Aureus sub-variant given the clinical description and age of the patient but clearly needs correlation as this group will have overlapping clinical/histological features.

The density and the depth of the infiltrate is rather impressive. 

Superficial and deep perivacular lymphocytic cuffing, a little spongiosis and panniculitis to add to the confusion!. To me it looks like a deep gyrate erythema- either erythema annulare centrifugum or erythema chronicum migrans if there is a history of tick bite.

Chronic cutaneous lupus erythematosus.

Many thanks everyone

The final diagnosis is:

Lichen aureus

Dr Richard Carr