PMC6362738_01
Waxy papular lesions over the trunk and back
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F1
On examination, he was found to have symmetric, waxy, papular lesions 3-4 mm in size, arranged in a linear pattern over the face, trunk, and the extremities [Figure 1].
Leonine facies and exaggeration of facial ridges
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F2
The patient had exaggeration of facial ridges and leonine facies [Figure 2].
Doughnut sign on the metacarpophalangeal joints
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F3
He was also found to have a "doughnut sign" on the metacarpophalangeal (MCP) joints of both hands [Figure 3].
Dermis shows a lesion with proliferating fibroblasts with few thick bundles of collagen (H and E, x20)
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F4
They revealed abundant interstitial mucin interspersed between collagen bundles in the dermis with increased fibroblasts [Figures 4 and 5].
Alcian blue stain highlights markedly increased dermal mucin (Alcian blue, x20)
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F5
They revealed abundant interstitial mucin interspersed between collagen bundles in the dermis with increased fibroblasts [Figures 4 and 5].