Presenter: Rick Lin, DO MPH, Dan Ladd, DO

Dermatology Program: KCOM Dermatology Department

Program Director: Bill Way, DO

Submitted on: Mar 21, 2002

CHIEF COMPLAINT:  Multiple Papular Lesions

CLINICAL HISTORY: A 38-year-old black female presented to the Dermatology Clinic with the chief complaint of multiple lesions on skin. The lesions onset 23 years ago, at age 15. The symptom includes severe itching. The lesions were previously diagnosed as keloids. Past treatments include topical steroids and oral antihistamines.

PHYSICAL EXAM:
Multiple elevated papular lesions with diameters ranging from 3-7mm distributed across bilateral arms. Hyperpigmentation is present in these lesions.

LABORATORY TESTS:

CBC – Within Normal Limits
Hepatic function panel – Within Normal Limits
HIV screen – Negative
Hepatitis Panel for A, B, C – Negative

DERMATOHISTOPATHOLOGY:

Deep shave biopsy of the lesion from the left forearm was performed.

Microscopic Description: hyperkeratotic and acanthotic epidermis with papillomatosis and psoriasiform hyperplasia. Prominent basal pigmentation. Thickening of the subepithelial collagen. Dermal fibrosis. Capillary proliferation, slight chronic inflammation, and scattered melanophages.

DIFFERENTIAL DIAGNOSIS:

1.   Keloids
2.   Prurigo nodularis
3.   Dermatofibroma
4.   Sarcoidosis