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February 2013

Hyperpigmented Patches on Shins, Palms, and Soles—Diagnosis

Author Affiliations
 

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

JAMA Dermatol. 2013;149(2):224. doi:10.1001/archderm.149.2.223-e

Histopathologic examination revealed epidermal spongiosis with a superficial to deep predominantly perivascular lymphohistiocytic infiltrate with red blood cell extravasation and hemosiderin deposition highlighted by iron stain. The findings are consistent with pigmented purpuric dermatosis (PPD).

Schamberg disease, or progressive PPD, was first described in the literature in 1901 by Schamberg as a “peculiar progressive pigmentary disease.”1(p165) It is part of a larger group of PPDs, which are chronic skin disorders characterized by a similar histopathologic picture of a perivascular infiltrate of lymphocytes and macrophages around superficial blood vessels with endothelial cell swelling and narrowing of lumina.2 There are several entities comprising PPDs, including Schamberg disease, pigmented purpuric lichenoid dermatosis (Gougerot and Blum), purpura annularis telangiectoides (Majocchi), and lichen aureus.1

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