PMC8558791_01
Skin biopsy showing exocytosis of lymphocytes, dyskeratosis, and pigment incontinence (a). The lymphocytic infiltrate was positive for CD8 (b).
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A skin biopsy was performed which showed exocytosis of lymphocytes, dyskeratosis, and pigment incontinence (Figure 1(a)). The lymphocytic infiltrate was a mixture of CD8-positive and CD4-positive populations with the CD8-positive lymphocytes outnumbering the CD4-positive cells in the epidermis (Figure 1(b)).
On the upper back (a), upper chest (b), and abdominal area (c) were scaly annular hyperpigmented plaques with an erythematous border. Significant induration of the plaques was noted on the abdomen.
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The patient's rash worsened to 90% of the patient's body's surface manifesting as lichenoid plaques with diffuse fibrosis and joint contractures (Figure 2).
The subsequent skin biopsy demonstrated prominent pigment incontinence with diffuse thickening of the collagen bundles in the dermis.
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This time there was more prominent pigment incontinence with diffuse thickening of the collagen bundles in the dermis that extended into the subcutaneous septa (Figure 3).