PMC3573822_01
Crusted ulcerated polymorphic lesions following a reticular pattern on the trunk, upper limb flexor zone and upper limbs, sparing the palms.
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F1
On physical examination, there were skin lesions in different evolutionary stages with reticular distribution, many of them ulcerated and coalescent (fig. 1), all over the body but sparing the palmar region, soles, scalp and ears.
Involvement of the genital region with secondary infection by S. aureus.
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F2
There were ulcerated lesions in the penile region, with yellowish discharge (fig. 2). The patient was treated for his infected penile region (fig. 2), but maintained daily high fever and skin lesions on the trunk and limbs.
a Recent skin lesion shows hyperkeratosis and acanthosis. b Presence of hyperkeratosis with foci of hemorrhage and degeneration of the basal layer. c Well-established lesion with necrosis and ulceration of the epidermis. d Perivascular lymphocytic inflammatory infiltrate in the dermis without atypia.
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F3
First, there was a recent skin lesion with hyperkeratosis and acanthosis (fig. 3a). Later, there was hyperkeratosis with hydropic degeneration of the basal layer and hemorrhagic focus (fig. 3b). There were well-established lesions with necrosis and ulceration of the epidermis (fig. 3c). A prominent inflammation with perivascular lymphocytic infiltrate extending throughout the dermis without atypia was also noted (fig. 3d).
Hyperchromic spots distributed throughout the body and keloid scarring lesions predominantly on the thorax and upper limbs.
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F4
On examination of the skin, a great number of keloid scars from the skin lesions were found (fig. 4).