case_images: PMC10467196_01
case_images: Tetrad of clinical photographs demonstrating the striking photo-distribution of lesions on the upper chest (panel a), lateral face and neck (panels b-d), and upper back (panels b) with notable sparing of portions of her shoulders, lower chest, and neck covered by her tank top and hair (panels a-c). The lesions on the head and neck display distinct raised, serpiginous borders (panel d).
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case_images: On physical examination, the patient had numerous erythematous, annular patches and plaques disseminated on the temples, lateral cheeks, lateral neck, superior chest, central superior upper back, proximal arms, dorsal forearms, dorsal hands, and distal legs (Figures 1-3). Many lesions had central clearing with hypopigmented atrophic centers and raised peripheral borders, some beaded and some serpiginous (Figures 1-4). The lesions were in a distinct photo-distrfibuted pattern on the neck and chest with obvious sparing of areas on her shoulders and chest covered by her sleeveless top, as well as the posterior portions of the neck covered by her hair (Figure 1).
case_images: Tetrad of clinical photographs in panels (a-d) showing numerous coalescing, erythematous plaques with central atrophy diffusely distributed on sun exposed areas of the bilateral upper extremities (dorsal forearms, bilateral proximal arm, and dorsal hands). Many plaques exhibit raised, serpiginous borders.
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case_images: On physical examination, the patient had numerous erythematous, annular patches and plaques disseminated on the temples, lateral cheeks, lateral neck, superior chest, central superior upper back, proximal arms, dorsal forearms, dorsal hands, and distal legs (Figures 1-3). Many lesions had central clearing with hypopigmented atrophic centers and raised peripheral borders, some beaded and some serpiginous (Figures 1-4). In areas of high lesion burden such as the upper extremities, many plaques were observed to coalesce (Figures 2 and 4).
case_images: Clinical photographs of the bilateral distal legs over the anterior tibial areas demonstrating large geographic plaques and scattered satellite papules with elevated erythematous borders and prominent hypopigmented atrophic centers. Panel (a) depicts the right leg and panel (b) depicts the left leg.
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case_images: PMC10467196_01_10.1177_2050313X231195487-fig3.jpg
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case_images: On physical examination, the patient had numerous erythematous, annular patches and plaques disseminated on the temples, lateral cheeks, lateral neck, superior chest, central superior upper back, proximal arms, dorsal forearms, dorsal hands, and distal legs (Figures 1-3). Many lesions had central clearing with hypopigmented atrophic centers and raised peripheral borders, some beaded and some serpiginous (Figures 1-4).
case_images: Close-up clinical view illustrating coalescing plaques on the right dorsal forearm to demonstrate the prominent raised, erythematous borders and notable central clearing with hypopigmentation and atrophy characterizing the typical morphology of the majority of this patient's lesions.
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case_images: PMC10467196_01_10.1177_2050313X231195487-fig4.jpg
case_images: fig4-2050313X231195487
case_images: Many lesions had central clearing with hypopigmented atrophic centers and raised peripheral borders, some beaded and some serpiginous (Figures 1-4). In areas of high lesion burden such as the upper extremities, many plaques were observed to coalesce (Figures 2 and 4).
case_images: Punch biopsy of skin biopsy (hematoxylin and eosin stain, magnification 2x) showing diffuse dermal palisaded granulomatous inflammation with scattered multinucleate cells.
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case_images: On histology, all three specimens demonstrated granulomatous inflammation and scattered multinucleate giant cells, with some containing intracellular elastic fibers consistent with elastophagocytosis (Figures 5-7).
case_images: Histopathologic image at higher magnification (hematoxylin and eosin stain, magnification 20x) showing numerous histiocytes and multinucleate cells, many of which contain intracellular elastic fibers consistent with elastophagocytosis.
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case_images: PMC10467196_01_10.1177_2050313X231195487-fig6.jpg
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case_images: On histology, all three specimens demonstrated granulomatous inflammation and scattered multinucleate giant cells, with some containing intracellular elastic fibers consistent with elastophagocytosis (Figures 5-7).
case_images: Elastin stain (Verhoeff-Van Gieson stain, magnification 20x) highlighting the intracellular elastic fibers within multinucleate cells, a phenomenon known as elastophagocytosis.
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case_images: On histology, all three specimens demonstrated granulomatous inflammation and scattered multinucleate giant cells, with some containing intracellular elastic fibers consistent with elastophagocytosis (Figures 5-7).