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June 2012

Long-term Nasal Plaque With Nasal Obstruction—Diagnosis

Arch Dermatol. 2012;148(6):755-760. doi:10.1001/archderm.148.6.756-b
Microscopic and laboratory findings and clinical course

Histopathologic analysis of the mucosal biopsy specimen revealed whorled collagenous tissue associated with a background inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. The fibrosis displayed an onionskin pattern (Figure 2).

Microscopic and laboratory findings and clinical course

The skin biopsy specimen revealed a dense inflammatory infiltrate in the dermis, consisting of numerous eosinophils, neutrophils, lymphocytes, and histiocytes, extending into the subcutaneous fat but separated from the epidermis by a conspicuous Grenz zone. Focal vascular changes compatible with vasculitis with fibrinoid necrosis and karyorrhexis were found. We observed perivascular dermal fibrosis with a storiform pattern (Figure 3). In this case, different patterns were found in the mucosa (onionskin pattern) and in the skin (storiform pattern).