A deep excisional skin biopsy specimen revealed a densely fibrotic dermis extending to the reticulm dermis and surrounding sweat glands. The fat and fascial layers contained thickened fibrous septa, with an inflammatory infiltrate consisting of lymphocytes and occasional eosinophils. The findings were thought to be most consistent with eosinophilic fasciitis.
All medications were discontinued for 3 months, and the disease progressed, with the onset of dysesthetic discomfort of the hands. Ultrasound confirmed and quantitated the thickening of the subcutaneous tissue of the arms and legs. The white blood cell count with differential revealed 19.8% eosinophils, with a total eosinophil count of 2100/µL. Prednisone therapy (60 mg/d) was initiated, and a 50% improvement was noted in 3 weeks. The patient's blood glucose levels increased; therefore, the dosage of prednisone was rapidly tapered and methotrexate therapy was begun.
Indurated Plaques on the Arms. Arch Dermatol. 2002;138(10):1371-1376. doi:10.1001/archderm.138.10.1371