Presenter: Suzanne Sirota Rozenberg, D.O.,Scott Goffin, D.O., Darren DiGulio, D.O., Yelva Lynfield, M.D., Marvin Watsky, D.O.

Dermatology Program: St. John’s Episcopal Hospital, Far Rockaway, New York

Program Director: Marvin Watsky, D.O.

Submitted on: May 30, 2003

CHIEF COMPLAINT: Itchy, dark rash on upper back for 5 years

CLINICAL HISTORY: Patient presented to clinic with concerns of an itchy, dark rash on his upper back for 5 years. The patient states that he was treated in Yemen with unknown topical medications. He states that he had some resolution, but then had recurrences. The patient states that he has no prior history of trauma or previous biopsy. He has no significant past medical history or surgical history, no known allergies, and no medications at this time.

PHYSICAL EXAM:
Large, hyperpigmented, triangular, slightly raised patch from the spine to the left posterior axillary line in the T2-T4 dermatome.

LABORATORY TESTS:

UA WNL
CBC WNL
SMA7 WNL

Thoracic spine x-ray-no definitive evidence of compression fracture, spondylolisthesis or disc narrowing

DERMATOHISTOPATHOLOGY:

Microscopic description: Punch biopsy: skin w/mild hyperkeratosis and minimal acanthosis, dermal melanophages, and hemosiderin deposits in the upper dermis where proliferation of small vessels is quite prominent.

Congo red stain neg.

DIFFERENTIAL DIAGNOSIS:

1.   Macular Amyloidosis
2.   Notalgia Parasthetica
3.   Herpes Zoster
4.   Lichen Simplex Chronicus
5.   Becker’s Nevus