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Off-Center Fold
August 2007

A Scaly Plaque on the Scalp—Diagnosis

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Arch Dermatol. 2007;143(8):1067-1072. doi:10.1001/archderm.143.8.1067-g

Pathologic examination of the biopsy specimen demonstrated a papillated epidermis with verrucoid hyperplasia, hyperkeratosis, parakeratosis, and hypergranulosis. The papillary dermis was filled with xanthomatous cells, which were periodic acid–Schiff negative. There was no epithelial atypia, and viral inclusions were absent. A dermal fibrosis was present along with a mixed lymphocytic and plasma cell perivascular infiltrate. The rest of the plaque was completely excised. The adjacent tissue revealed thickened organized collagen, with loss of follicular and adenexal structures. However, there was no apparent thickening of the basement membrane. Follow-up examination at 6 weeks showed no evidence of VX recurrence or active lesions of DLE.

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