PMC3322625_01
a Tophi on the pulpa of the 2nd finger on the right hand. b Urate crystals in OCT appear as hyperreflective, rounded, cloud-like areas, the upper part sharply delineated by a hyporeflective fringe representing granulomatous tissue. c Hematoxylin-eosin stain of biopsy showing multiple uric acid crystals in the dermis with surrounding granulomatous tissue.
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F1
A 50-year-old kidney transplanted male, presented to the Department of Dermatology of Roskilde with a 5-8 year history of white papules on the pulpa of the right phalanx of the 2nd finger (fig. 1a). The surrounding tissue appeared hyperreflective like the lesions, but was delineated because of the hyporeflective fringe (fig. 1b). The vessels appeared dilated (fig. 1c).
PMC3322625_02
a Papular/generalized GA on the right elbow of the patient. b1 OCT image of a rounded, nonspecific structure found in GA. Note the absence of the distinctive hyporeflective halo associated with basal cell carcinoma. b2 OCT image showing an oblong, wing-like structure that resembles the histological distribution of diffuse GA or a lymphocytic infiltrate. c Hematoxylin-eosin stain of biopsy of a GA papule showing a granuloma (blue arrow) and perivascular lymphocytic infiltrates (green arrow).
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F2
The papules were seen on both elbows (fig. 2a). Lesional OCT scan showed changes in dermis consisting of hyporeflective, rounded and lobulated, wing-like structures found in the papular lesions of the elbows (fig. 2b). The vessels seemed dilated and more pronounced compared to normal skin, and the lobulated structure appeared in extension of a vessel (fig. 2b2). Central mucin deposits were found consistent with the diagnosis of GA (fig. 2c).