case_images: PMC11001283_01
case_images: Multiple brownish papules on the back (a); multiple brownish papules on the chest (b); multiple brownish papules on the head/neck region (c); multiple brownish papules on the head/neck region, lateral view (d); dermoscopy of one lesion showed peripheral hyperpigmentation, with central pale amorphous brownish area, consistent with dermatofibroma-like pattern (e); RCM of one lesion showed increased vascularization of the papillary dermis along with extended fibrotic areas and scattered hyper-reflective cells, corresponding to dermal plasma cells. The general RCM features show a dermatofibroma-like pattern with inflammatory cells (f); cutaneous biopsy of one lesion showed dermal perivascular plasmocellular infiltrate, with mild remodeling of collagen bundles (Hematoxylin and eosin. x100) (g).
case_images: cde-2024-0016-0001-536483_F01.jpg
case_images: PMC11001283_01_cde-2024-0016-0001-536483_F01.jpg
case_images: F1
case_images: IL-6 (162 pg/mL), and polyclonal hyper-gamma-globulinemia. In vivo reflectance confocal microscopy (RCM) of one erythematous lesion showed no epidermal changes with hyper-reflective papillae and increased vascularization of the papillary dermis, with scattered hyper-reflective cells (corresponding to inflammatory cells), along with extended fibrotic areas (Fig. 1a-f).
case_images: Improvement of cutaneous lesions after 15 months of follow-up, with combined siltuximab and 1,927 nm fractional laser treatment (a-d); dermoscopy showing reduction of erythema, with central scarring area and peripheral hyperpigmentation, in the setting of dermatofibroma-like pattern (e); RCM showing only fibrotic bundles with remodeling of superficial dermis in absence of hyper-reflective inflammatory cells (f).
case_images: cde-2024-0016-0001-536483_F02.jpg
case_images: PMC11001283_01_cde-2024-0016-0001-536483_F02.jpg
case_images: F2
case_images: DLQI = 5. Dermoscopy was characterized by persisting, but reduced, dermatofibroma-like pattern with decreased pigmentation and erythema and reduction of the central scarring area, while RCM showed the thickening of dermal fibers with remodeling of superficial dermis and absence of dermal inflammatory infiltrate (Fig. 2a-f).