PMC4677178_01
Keloidal scleroderma. Multiple, scattered, and hyperpigmented nodules overlying plaques along the trunk and upper extremities.
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Physical examination revealed dark brown indurated nodules with a slightly violaceous border over the chest and breasts along with smaller hyperpigmented plaques scattered over the abdomen (Figure 1).
Keloidal scleroderma. Histologic sections show an acanthotic epidermis with overlying basilar hyperpigmentation. Within the dermis there is a proliferation of myofibroblasts and thickened collagen bundles. There is a lack of vertically oriented blood vessels and a lack of atrophy of the overlying epidermis speaking against that of a keloid or scar. At low power (2x) biopsy has a barrel-shaped appearance. The dermal component is expansile and extends beyond that of the epidermal component.
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The dermal component is expansile and extends beyond that of the epidermal component (Figure 2).
A tissue elastic stain shows preserved elastic fibers within areas of scleroderma. In areas of keloid these elastic fibers are typically absent, thus supporting the diagnosis of keloidal scleroderma and not that of a keloid.
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A tissue elastic stain shows preserved elastic fibers within areas of scleroderma (Figure 3).