PMC9779987_01
Clinical photographs show areas of diffuse indurated, sagging skin, with decreased elasticity and fine scaling. (a) Ventral forearms and wrists. (b) Posterior thighs.
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fig1
The rash started as rough spots on the volar wrists and posterior knees that progressed into diffuse areas of loose, sagging skin involving the trunk, extremities, and intertriginous areas (Figure 1).
Punch biopsy showed thickened dermal collagen bundles, eccrine gland entrapment, and sparse plasma cells in the deep reticular dermis. (hematoxylin-eosin stain, original magnifications (a) x40, (b) x100, and (c) x200).
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fig2
Punch biopsies of the calf and thigh both showed thickened dermal collagen bundles, eccrine gland entrapment, and sparse, plasma cell-rich, chronic inflammation along the dermal-subcutaneous junction (Figure 2).