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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 2499 - 04 February 2020 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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65F, with dementia and multiple medical conditions, now with numerous
excoriated plaques on upper and lower extremities. Bx from left lower leg.


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Saman Fatah

Posted (edited)

On a quick glance, some of the histology features suggests nodular prurigo but there is a ? sub-epidermal split near the middle of the photomicrographs. Dermal inflammatory changes are minimal and no convincing interface changes.

More history will be useful such any blisters at any stage mixed with the described skin changes. DIF/ELISA for BP180/230 would be important ancillary tests to rule out unusual to rare variants of BP especially pemphigoid nodularis.

Finally, in this age group one has to be aware of common dermatoses with unusual presentations such as scabies though the sparse inflammatory changes in dermis would be a bit unusual.

 

Edited by Saman Fatah
Typo

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I see only lichen simplex chronicus alterations.

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Uma Sundram

Posted

Lichen simplex chronicus/prurigo nodularis. DIF was negative. I like the idea of unusual blistering disorders; one could also consider late presentations of genodermatoses such as acrodermatitis verruciformis, Darier disease and acquired ichthyosis. The clinical lesions did not fit with these latter considerations. 

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