Case Number : Case 2343 - 10 June 2019 Posted By: Limin Yu

Lichen striatus comes to mind. Not sure. Need more clinical.

Epidermal necrosis with underlying lymphocytic vasculitis. Malignant atrophic papulosis (Degos's disease) or drug induced vasculitis. Clinical correlation is needed

Epidermal necrosis with intact lichenoid superficial and deep infiltrate.  I can think of PLEVA. Other d/d could include drug, bite (although no eosinophils) and DLE. Need cpc.

Insect bite.

Epidermal necrosis and wedge shape infiltrate of lymphocites. I favor PLEVA, but if the lesion is solitary could be a Insect Bite. CPC is needed

I do not expect deep inflamatory infiltrate in PLEVA. At first glance, I thought about insect bite reaction, but I do not see eosinophils and mucin deposits. But I can see some intraepidermal lymphocytes in a crusted lesion and deep inflamatory infiltrate. Lymphomatoid papulosis is my best hypothesis.

4 hours ago, IgorSC said:

I do not expect deep inflamatory infiltrate in PLEVA. At first glance, I thought about insect bite reaction, but I do not see eosinophils and mucin deposits. But I can see some intraepidermal lymphocytes in a crusted lesion and deep inflamatory infiltrate. Lymphomatoid papulosis is my best hypothesis.

Agree! I didn't see the intraepidermal lymphocytes with clear halo, before...So a type B LyP could be a good differential.

Thanks for the great dicussions above! My initial thoughts were PLEVA vs. bite vs. equestrian perniosis. I agree Lyp needs to be ruled out. 

Equestrian perniosis was my favoured but good suggesions above. Shame Limin gave up responding!