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Winter 2016, Vol. 24 No. 4

Hong Kong J. Dermatol. Venereol. (2016) 24, 216-217


Dermato-venereological Quiz

Dermato-venereological Quiz

ECY Chu 朱灼欣 and WY Lam 林偉業

A 62-year-old female patient presented with on and off painful ulcerated plaques on the upper and lower limbs for years. She was seen by doctors in China and treated with methylprednisolone and TCM "lei gong teng". The lesions improved and healed with atrophic scars. Lesions soon recurred after stopping the medications. On physical examination, there were multiple ulcerated plaques with violaceous border over the upper limbs and lower limbs (Figure 1). Blood tests including CBC, L/RFT, ANA, ANCA, Anti-ENA, RF, C3 and C4 were all normal. A skin biopsy was undertaken on the left upper limb (Figures 2 and 3).

Figure 1 Violaceous plaque with ulceration.

Figure 2 Low power view (H&E, original magnification x 40).

Figure 3 High power view (H&E, original magnification x 400)

Questions

  1. What are the differential diagnoses?
  2. What are the histological findings of the skin biopsy?
  3. What is the diagnosis?
  4. What is the treatment?