PMC9789704_01
(A and B) Hyperkeratotic papules and plaques, scales, lichenification, and hyperpigmented macules on the extensor surfaces of both arms.(C and D). Clinical improvement after the 3rd month of observation.
IMCRJ-15-745-g0001.jpg
PMC9789704_01_IMCRJ-15-745-g0001.jpg
f0001
Dermatological status showed multiple papules and hyperkeratotic plaques, scale, lichenification, and hyperpigmented macules, some confluent, measuring 0.2x0.2 cm to 1x1 cm and 0.2x0.2x0.1 cm to 5x5x0.3 cm in size, well-defined, partially raised, dry, located regionally on the extensor surfaces of both arms (Figures 1A and B). In the third month of observation, there was a partial improvement of the skin lesions in the form of thinning of the hyperkeratotic papules and plaques on both arms (Figures 1C and D) and hyperkeratotic papules and nodules on both legs (Figures 2D-F).
(A-C) Hyperkeratotic papules and nodules, scales, and hyperpigmented macules on the extensor surfaces of both legs. (D-F) Clinical improvement after the 3rd month of observation.
IMCRJ-15-745-g0002.jpg
PMC9789704_01_IMCRJ-15-745-g0002.jpg
f0002
The Koebner phenomenon was identified (Figures 2A-C).   In the third month of observation, there was a partial improvement of the skin lesions in the form of thinning of the hyperkeratotic papules and plaques on both arms (Figures 1C and D) and hyperkeratotic papules and nodules on both legs (Figures 2D-F).
Histopathological examination of the biopsy specimen from the right arm. (A) HE-staining showed hyperkeratosis and acanthosis of the epidermis as well as eosinophilic mass deposit in the dermis (red circles). (B) Congo red staining showed reddish-Orange amyloid deposits in the papillary dermis (yellow circles).
IMCRJ-15-745-g0003.jpg
PMC9789704_01_IMCRJ-15-745-g0003.jpg
f0003
Histopathological examination with hematoxylin-eosin (HE) staining from the lesion on the left arm showed an eosinophilic mass deposit in the dermal papillae, covered with hyperkeratotic and acanthotic epidermis (Figure 3A). Congo red staining of the biopsy specimen from the left arm revealed an orange amyloid deposit (Figure 3B), supporting the diagnosis of LA.
Histopathological examination of the biopsy specimen from the left leg. (A) HE-staining of the biopsy specimen from the left leg showed the epidermal surface forming a cup-like shape containing a mass of keratin and collagen (red circle), surrounded by infiltration of lymphocyte inflammatory cells. (B) Masson's trichrome staining showed elimination of the bluish collagen mass (yellow circle) from the dermis to the epidermis.
IMCRJ-15-745-g0004.jpg
PMC9789704_01_IMCRJ-15-745-g0004.jpg
f0004
The diagnosis was confirmed through Congo red staining to identify the presence of amyloid deposits in LA and Masson's trichrome staining to identify the presence of collagen in ARPC (Figure 4A). Elimination of the bluish-colored collagen mass from the dermal reticular layer to the epidermis (Figure 4B) was identified on Masson's trichrome staining, supporting the diagnosis of ARPC.