MICHAEL E.MINGMD, MSCE
CARRIE ANN R.CUSACKMDSENAIT W.DYSONMDJACQUELINE M.JUNKINS-HOPKINSMDVINCENTLIUMDKARLA S.ROSENMANMD
Biopsy sections from the dorsal side of the hand (Figure 2) show an acanthotic, hyperkeratotic, and parakeratotic epidermis. There is focal atypia of keratinocytes with hyperchromatic and pleomorphic nuclei and abundant pale pink–staining cytoplasm. There is a lichenoid lymphocytic infiltrate with dyskeratotic keratinocytes. A periodic acid–Schiff with diastase digestion stain showed focally thickened basement membrane zone, and an alcian blue stain demonstrated increased mucin deposition. A Verhoff van Gieson stain was positive for transepidermal elimination of elastin (Figure 3). Two months after intralesional corticosteroid injections and daily topical corticosteroid application, the patient had good clinical response, which lends further support to our diagnosis.
Recurrent Hypertrophic Nodules on the Bilateral Arms—Diagnosis. Arch Dermatol. 2009;145(4):479-484. doi:10.1001/archdermatol.2009.34-b