PMC6362733_01
Sclerodermoid changes over the face with deepening of furrows over the forehead. Diffuse thickening of the skin. There is diffuse infiltration over the entire helix and earlobe. Few papulonodular lesions can be appreciated over the helix
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F1
On close inspection of the back, multiple closely grouped papular lesions can be appreciated over the back, giving a rough, cobblestone-like texture to the skin
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F2
There is a prominence of follicular ostia visible near the cubital fossae (a). Sclerodermoid skin changes over the shins and (b) forearms
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F3
Histopathological examination reveals excessive fibroblastic proliferation and dermal fibrosis (H and E, x4)
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F4
Hematoxylin and eosin staining of the skin biopsy specimen showed widely separated dermal collagen fibers and fibroblastic proliferation [Figure 4].
Special staining with colloidal iron showed amorphous blue-colored mucin deposition throughout the dermis, which in correlation with the histopathological picture is diagnostic for scleromyxoedema. Counter stain used: Hematoxylin (Colloidal iron stain: x10)
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F5
Colloidal iron special staining showed an increased mucin deposition between the dermal collagen fibers [Figure 5], which further clinched the diagnosis.