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JAMA Dermatology Clinicopathological Challenge
May 2015

Stellate Red-Brown Patches on the Distal Extremities

Author Affiliations
  • 1Department of Dermatology, Northwestern University, Chicago, Illinois
JAMA Dermatol. 2015;151(5):549-550. doi:10.1001/jamadermatol.2014.4479

A woman in her 40s with a history of atopy presented with a 1-year history of asymptomatic red-brown patches on the distal extensor extremities. The lesions began on the bilateral lower legs and spread to the thighs, buttocks, hands, forearms, and proximal arms. Physical examination revealed numerous stellate red-brown patches without induration, scale, or ulceration (Figure, A). Review of systems was notable for episodic muscle cramping and numbness involving the lower extremities. The patient had no notable recent medical illnesses, illicit drug use, or new medications. An incisional wedge biopsy was performed on a lesion from the lower extremity, and the specimen was stained with hematoxylin-eosin (Figure, B and C).

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