PMC10264797_01
Clinical pictures showing (A) an elevated, violaceous plaque with an ulcerated center and crusted edges on the left leg of the patient; (B) after 3 months of therapy the lesions was substantially healed with a flat, atrophic surface and a wrinkled paper appearance; (C,D) a detail of the others atrophic and hyperpigmented sequelae resulting from previous erosive lesions on the left leg of the patient.
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Dermatologic examination revealed a large, ulcerated lesion with elevated violaceous border and crusted edges on the left leg of the patient (Figure 1A). At the three months dermatological follow-up the lesions were partially healed and appeared as multiple irregular erosions with a crusted and scaly surface located on the left leg of the young patient; the bigger lesions healed with a sclerotic and atrophic retracting scar tissue with a "wrinkled paper" appearance (Figures 1B-D).
Histopathology of the lesions showing (A) an area of ulceration with cellular debris and neutrophils (on the right side), epidermal hyperplasia, and a dense inflammatory infiltrate with abundant neutrophils in the mid-to-deep dermis, together with extensive areas of necrosis and dilated blood vessels (haematoxylin and eosin staining, x4); (B) a detail of the epidermal hyperplasia presenting with a pseudo-carcinomatous appearance (haematoxylin and eosin staining, x10); (C) a detail of the dermal area of necrosis with dilated blood vessels and abundant inflammatory infiltrate (haematoxylin and eosin staining, x10); (D) a close-up view of the dermal admixed inflammatory infiltrate, mainly composed of neutrophils (haematoxylin and eosin staining, x20).
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An incisional biopsy of the ulcerative lesion was performed for histopathological examination, that revealed a pseudo-carcinomatous epidermal hyperplasia, with an admixed inflammatory infiltrate mainly composed of neutrophils in the mid-to-deep dermis with areas of necrosis and reactive angiogenesis (Figure 2).