case_images: PMC6362738_01
case_images: Waxy papular lesions over the trunk and back
case_images: IDOJ-10-50-g001.jpg
case_images: PMC6362738_01_IDOJ-10-50-g001.jpg
case_images: F1
case_images: On examination, he was found to have symmetric, waxy, papular lesions 3-4 mm in size, arranged in a linear pattern over the face, trunk, and the extremities [Figure 1].
case_images: Leonine facies and exaggeration of facial ridges
case_images: IDOJ-10-50-g002.jpg
case_images: PMC6362738_01_IDOJ-10-50-g002.jpg
case_images: F2
case_images: The patient had exaggeration of facial ridges and leonine facies [Figure 2].
case_images: Doughnut sign on the metacarpophalangeal joints
case_images: IDOJ-10-50-g003.jpg
case_images: PMC6362738_01_IDOJ-10-50-g003.jpg
case_images: F3
case_images: He was also found to have a "doughnut sign" on the metacarpophalangeal (MCP) joints of both hands [Figure 3].
case_images: Dermis shows a lesion with proliferating fibroblasts with few thick bundles of collagen (H and E, x20)
case_images: IDOJ-10-50-g004.jpg
case_images: PMC6362738_01_IDOJ-10-50-g004.jpg
case_images: F4
case_images: They revealed abundant interstitial mucin interspersed between collagen bundles in the dermis with increased fibroblasts [Figures 4 and 5].
case_images: Alcian blue stain highlights markedly increased dermal mucin (Alcian blue, x20)
case_images: IDOJ-10-50-g005.jpg
case_images: PMC6362738_01_IDOJ-10-50-g005.jpg
case_images: F5
case_images: They revealed abundant interstitial mucin interspersed between collagen bundles in the dermis with increased fibroblasts [Figures 4 and 5].