PMC10293941_01
Multiple 0.5- to 1-mm nonblanchable erythematous to brownish macules and papules coalescing into patches and plaques on both lower legs.
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F1
Thai woman presented with a chronic, progressive, mildly pruritic eruption on both shins that had been present for 3 years (shown in Fig. 1).
Dermatoscopy of the lesions showed red-brown spots and globules arranged on background of coppery-red pigmentation.
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F2
Dermatoscopy revealed reddish-brown spots and globules arranged on a copper-red-pigmented background (shown in Fig. 2).
a Dense patchy inflammatory cells infiltration forming non-necrotizing granulomas in the papillary dermis and red blood cells extravasation (hematoxylin and eosin. x100). b The inflammatory cells in the granulomas are mainly composed of lymphocytes and histiocytes (x400). c Hemosiderin deposits in the dermis, especially surrounding the granulomas (arrow). d Perl's Prussian iron stain demonstrates the presence of abundant dermal hemosiderin deposits (Prussian blue iron stain. x100).
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F3
Hemosiderophages and hemosiderin surrounded the blood vessels and granulomas (shown in Fig. 3).
Significant improvement and marked flattening of the lesions with residual hyperpigmentation on the lower legs after 3 months of topical corticosteroids and oral colchicine.
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F4
After 3 months of this combination therapy, the lesions, especially the erythematous papules, had flattened and the pruritus had disappeared (shown in Fig. 4).