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Nov 2011

Pruritic Scaly Rash on Arms and Legs —Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(11):1317-1322. doi:10.1001/archdermatol.2011.325-b

Two skin biopsy specimens from different lesions on the legs showed similar findings. Epidermal changes included hyperkeratosis with focal parakeratosis, atrophy alternating with irregular acanthosis, basal vacuolar change with numerous dyskeratotic keratinocytes, and exocytosis of lymphocytes. There was a patchy lichenoid infiltrate composed of lymphocytes, histiocytes, and admixed plasma cells (Figure 3). Ectatic vessels were present in the papillary dermis, and there was a mild perivascular and periadnexal lymphocytic infiltrate. These findings are consistent with a diagnosis of KLC. Treatment with acitretin, 25 mg daily, led to 50% improvement in her lesions by the 2-month follow-up.

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