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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 2684 - 20 October 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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39 year old female with pretibial lesion.


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Richard Logan

Posted

Another top-heavy histology.  This is a small lesion with full-thickness epidermal necrosis and adherent crust.  Not much underlying inflammation making ecthyma unlikely. 

I think this is a lesion with exogenous cause - dermatitis artefacta, or some form of thermal or chemical injury.

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A perforating dermatitis with trans epidermal elimination of cellular debris containing collagen vertical fibers. I don’t  know if it is Acquired Collagenosis Perforance or some other similar pathology ( dyabethic? Renal failure? traumatism? ) Waiting for the answer. 
 

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Saman Fatah

Posted

Agree with Vincenzo, it looks like a biopsy that was taken from a relatively late/old lesion of a perforating dermatoses showing mostly trans-epidermal component in the available sections. Further levels/stains may shed more light on what is eliminated and any dermal component/connection.

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Meenakshi Batrani

Posted

Agree with perforating dermatosis- transepidermal elimination of collagen fibers is evident. 

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Uma Sundram

Posted

Acquired perforating disorder. The patient has chronic renal failure and is on dialysis.

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