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The skin biopsy specimen demonstrated an ulcer surrounded by a dense cellular infiltrate composed of eosinophils, lymphocytes, and histiocytes with abundant eosinophilic cytoplasm, vesicular nuclear chromatin, and nuclear grooves. The histiocytes were positive for S100 protein. On electron microscopy, a population of histiocytes with Birbeck granules (Langerhans histiocytes) was identified.
Clinically, various topical agents, including antibiotic ointments and creams and bland emollients, were applied to the ulcers. However, the patient felt even more pronounced pain and preferred observation only. He was followed up for 6 months, with no change in his skin condition.
Nonhealing Perianal Ulcers—Diagnosis. Arch Dermatol. 2005;141(9):1161-1166. doi:10.1001/archderm.141.9.1161-g