Microscopic examination of the biopsy specimen showed focal crust overlying a thinned epidermis, with areas of parakeratosis. The underlying papillaryand reticular dermis contained focal areas of "necrobiosis" surrounded by lymphocytes, palisading histiocytes, epithelioid cells, and occasional multinucleatedgiant cells (Figure 3 and Figure 4). The patient was given trials ofniacinamide and tazarotene cream, with no improvement of the GA. Oral hydroxychloroquine sulfate therapy (200 mg twice daily) was initiated and continued for 20 months.The GA began clearing in several months and was completely resolved after 18 months of hydroxychloroquine treatment.
Progressive Diffuse Papules in a Child—Diagnosis. Arch Dermatol. 2004;140(7):877-882. doi:10.1001/archderm.140.7.877-h