Interactive Case Study - April 2023

Question 1:

A 58-year-old man presents with multiple erythematous to purple, asymptomatic, slightly indurated thin plaques without surface change on his trunk, lower back, right leg, and arms (Figures 1-3). They developed over the past year and deepened in color. He has no personal or family history of eczema, allergic rhinitis, asthma, or psoriasis.
 
A 4 mm punch biopsy from the flank was obtained and results are shown below (Figures 4-7; figure 6 is CD34 stain, figure 7 is EVG stain).
 
What is the best diagnosis?

Figure 1:


Figure 2:


Figure 3:


Figure 4: H&E


Figure 5: H&E


Figure 6: CD34


Figure 7: EVG

A.  Atrophoderma of Pasini and Pierini

B.  Lichen sclerosus

C.  Porphyria cutanea tarda

D.  Superficial morphea

E.  Werner Syndrome