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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 1992 - 24 Jan 2018 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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68 year old male. Patient developed extensive rash 2 years ago whilst in ITU. He developed quite an inflammatory looking eruption which has faded to the current appearance (images 1 and 2). The lesions are fairly stubborn and static (pale tan coloured with a fairly well demarcated border). Clinically - lichenoid eruption ? Drug eruption.

Edited by Admin_Dermpath


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Dr. Richard Carr

Posted

I liked the first citation in particular!

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Saman Fatah

Posted

The main feature on clinical photos which is difficult to magnify is light brown macules but one can not comment if any of these has a raised ridges edges (which needs to be carefully searched for).

The histology shows features of "developing" cornoid lamella with pigment incontinence. in papillary dermis

This looks like a rare variant of porokeratosis EPPK (Eruptive Pruritic Papular Porokeratosis )where the inflammatory phase improved to a certain degree leaving residual lesions and post inflammatory changes.

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Dr. Mona Abdel-Halim

Posted

Fits with eruptive pruritic papular porokeratosis as Dr Fatah said 

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vincenzo polizzi

Posted

Please Dr Iskander, what's the diagnosis of case n. 1987?

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Nitin Khirwadkar

Posted

Looks like EPPP. Were the lesions pruritic? Some of these have been reported in patients with internal malignancies.

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Admin_Dermpath

Posted

Hi,

 

Dr Chaudhry has added the MelanA for this case. He will add the diagnosis within the next day.

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The word ' persistent' needs to be added to the terminology to describe this case

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Admin_Dermpath

Posted

Dear All 

 

Dr Chaudhry checked with the clinician and the rash is not pruritic 

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Admin_Dermpath

Posted

Dr Chaudhry's comments

'In some of the literature eruptive disseminated porokeratosis (EDP) is an umbrella term which encompasses eruptive pruritic papular porokeratosis (EPPP). Given the lack of pruritus and lack of papules in this case we felt EDP is preferable to EPPP. As stated by NItin EDP has an association with malignancy (hepatocellular carcinoma, cholangiocarcinoma), but others include ovarian carcinoma and lymphoma. so one should scan patients with this diagnosis. 

So many thanks again for your expert insights into this case.

Iskander '

 

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