PMC3663388_01
Two of the reddish-brown plaques on the leg. Note the difference in their clinical appearance. [Copyright:  2013 Khan et al.]
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Physical examination revealed annular waxy brown plaques with central atrophy and a lilac colored advancing edge located on the left posterior-lateral calf measuring 5 x 4 cm (Figure 1), left dorsal hand 5 x 3.5 cm and left forearm 11 x 9 cm.
Hyperkeratotic scaling of the plaque on the right anterior shin. [Copyright:  2013 Khan et al.]
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Interestingly, a 5.5 x 4.5 cm plaque on the right anterior lower leg exhibited central hyperkeratosis as opposed to atrophy (Figure 2).
An interstitial granulomatous dermatitis aligned parallel to the skin surface (H&E, original magnification 100x). [Copyright:  2013 Khan et al.]
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A subsequent biopsy of an adjacent area demonstrated an attenuated epidermis with diffuse and palisaded granulomatous inflammation within the deeper levels of the dermis (Figure 3).
A mixed perivascular infiltrate composed of lymphocytes and histiocytes with plasma cells (H&E, original magnification 400x). [Copyright:  2013 Khan et al.]
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The inflammatory infiltrate was composed of lymphocytes and histiocytes, admixed with scattered perivascular plasma cells (Figure 4).