Case Number : Case 2770 - 17 February 2021 Posted By: Dr. Hafeez Diwan

I am assuming that the blue staining in the dermis is artefactual via the split in the epidermis.

The epidermis shows pigmentation which is probably constitutional.  There is a degree of predominantly parakeratotic hyperkeratosis.  Beneath this there is patchy pallor affecting the uppermost cells of the Malpigian layer, and a mild perivascular inflammatory infiltrate with vascular dilation.

I would consider nutritional deficiency such as pellagra, zinc deficiency or the early stages of necrolytic migratory erythema.

2 hours ago, Richard Logan said:

I am assuming that the blue staining in the dermis is artefactual via the split in the epidermis.

The epidermis shows pigmentation which is probably constitutional.  There is a degree of predominantly parakeratotic hyperkeratosis.  Beneath this there is patchy pallor affecting the uppermost cells of the Malpigian layer, and a mild perivascular inflammatory infiltrate with vascular dilation.

I would consider nutritional deficiency such as pellagra, zinc deficiency or the early stages of necrolytic migratory erythema.

Agree. I thinking in Nutritional deficiency too

Agree with the above. Covid status?

Agree with nutritional deficiency 

I didn’t get there alone, but agree with above. 

Sorry for the delayed response.  Patient is COVID-19 negative.  Nutritional deficiency.