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JAMA Dermatology Clinicopathological Challenge
June 2014

Polymorphic Plaques Involving the Face and Extremities

Author Affiliations
  • 1Baylor University Medical Center, Dallas, Texas
JAMA Dermatol. 2014;150(6):643-644. doi:10.1001/jamadermatol.2013.8753

A previously healthy man in his 30s requested a second opinion after a recent diagnosis of cutaneous sarcoidosis. He presented with a 14-month history of several pink plaques, initially on his face with subsequent involvement of the proximal arms and legs. He denied any constitutional symptoms, arthralgias, night sweats, dyspnea, motor weakness, or sick contacts. He had immigrated to the United States in 2002 from Chennai, India, with return visits approximately every 2 years. On physical examination, he had 5 discoid, annular, and geographic erythematous plaques with minimal overlying scale over his face, upper arms, and right thigh. A representative plaque over the left upper arm is depicted in the Figure, A. Pin-prick testing suggested lesional anesthesia. No hand or foot joint deformities, palpable peripheral nerves, motor neuropathy, or mucosal involvement were noted. Findings from laboratory tests, including a complete blood cell count, compressive metabolic panel, antinuclear antibody, angiotensin-converting enzyme and calcium levels, and C-reactive protein were unremarkable. Results from a purified protein derivative (PPD) skin test were negative. Results from a chest radiograph was normal. Punch biopsies for histopathologic examination (Figure, B and C) and polymerase chain reaction testing for the suspected causative organism were performed.

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