65-year-old gentleman with erythematous induration of the skin on his back

Presenter: Donna Tran, DO
Dermatology Program: Western University / College Medical Center
Program Director: Navid Nami, DO, FAOCD
Submitted on: Jan 5, 2014

CHIEF COMPLAINT:  A 65-year-old gentleman presented to our dermatology clinic with complaints of hardening of his back.

CLINICAL HISTORY:

Signs and symptoms:  Painless, progressive hardening of his upper back present for years. He denied any associated symptoms.

Previous Treatment:  Denied.

Other information:  Past medical history was significant for insulin-dependent diabetes mellitus.

PHYSICAL EXAM:

Physical examination revealed a symmetrical, erythematous, indurated plaque with indistinct borders involving his posterior neck and upper back (Figure 1). No restriction in range of motion of the shoulders and neck was noted.

 

Figure 1

LABORATORY TESTS:

None.

DERMATOHISTOPATHOLOGY:

Histopathologic examination of a punch biopsy specimen revealed an intact epidermis with no interface changes. A scant superficial perivascular lymphocytic infiltrate was present (Figure 2). A colloidal iron stain revealed an increase in dermal mucin (Figure 3).

 

Figure 2

 

Figure 3

DIFFERENTIAL DIAGNOSIS:

1.   Morphea
2.   Cellulitis
3.   Scleredema
4.   Scleromyxedema
5.   Scleroderma


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