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March 2009

Atrophic Scars in a 54-Year-Old Woman—Diagnosis

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Arch Dermatol. 2009;145(3):321-326. doi:10.1001/archdermatol.2008.627-b

On low-power microscopy, a large wedge-shaped area of ischemia and necrosis is visible. The epidermis is atrophic, and the dermis is edematous and paucicellular. At the base of the ischemic dermis is an artery exhibiting endothelial proliferation and vessel wall thickening. No thrombus is noted within this vessel. There is a sparse perivascular lymphocytic infiltrate.

Our patient unfortunately continues to develop lesions despite therapeutic trials of cyclosporine, methotrexate, cyclophosphamide, and intravenous immunoglobulin. She is prescribed aspirin, 75 mg/d, and pentoxifylline, 400 mg, 3 times a day. Our patient describes intense pain in the ulcerated lesions for which she has required intravenous ketamine hydrochloride periodically. Over 9 years of follow-up she has not developed any systemic symptoms despite extensive cutaneous disease.

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