PMC9019370_01
Poorly demarcated, exfoliative, erythematous eruption involving the, neck and upper chest (a), and arms (b). Multiple erosive papules with overlying crust were notable on the arms (c). Violaceous-to-dark brown macules and patches were scattered on the arms, neck, and chest.
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A 58-year-old woman living in rural Saskatchewan, Canada presented with a 2-month history of a pruritic, desquamating, purpuric, exfoliating skin rash affecting the extremities and trunk and sparing the face and mucosal membranes (Figure 1).
Photomicrograph, Hematoxylin and eosin (H&E) stains. Punch biopsy of skin notable for both thinning of the epidermis (a and b) and hyperplastic changes (c). Brisk vacuolar-type interface dermatitis was evident (c and d), with civatte and colloid bodies readily identified (d). In other areas, classic lichen planus-like changes were appreciated with irregular epidermal acanthosis and prominent "saw toothing" of the epidermis and overlying compact orthohyperkeratotic scale. The papillary dermis was significant for perivascular lymphohistiocytic inflammation with eosinophils as well as small, non-necrotizing granulomas (e and f).
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Punch biopsies in areas of scaling over the right thigh were performed and showed a mixed dermatitis (Figure 2).