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JAMA Dermatology Clinicopathological Challenge
September 2016

Large Annular Plaque on the Arm of a Patient With Recurrent Headaches

Author Affiliations
  • 1Faculty of Medicine, University of Concepción, Chile
  • 2Dermatology Department, Guillermo Grant Benavente Regional Hospital, Concepción, Chile
JAMA Dermatol. 2016;152(9):1045-1046. doi:10.1001/jamadermatol.2016.1532

A woman in her 50s presented to the dermatology clinic with a 3-year history of a slightly pruritic steadily growing plaque on her right arm. She had consulted a dermatologist 18 months prior, who performed a biopsy of the lesion that was inconclusive. No treatment was prescribed at the time. She denied any systemic symptoms. Her medical history was relevant for multiple consultations with several neurologists in the past 2 years for intermittent moderate-to-severe unilateral headache with an unsatisfactory response to nonsteroidal antiinflammatory drugs and amitriptyline. She was not taking any medication at the time of consultation. Clinical examination revealed a 12-cm-wide, soft, nontender plaque with a raised, nodular, and slightly desquamative erythematoviolaceous border and a clear, atrophic center with an increase in wrinkle depth on her upper right arm (Figure, A). There were no other mucosal or skin lesions. Her neurological and mental state examination showed no abnormalities. No physical examination was performed specifically to the head and neck. A biopsy specimen that included the border of the lesion was obtained (Figure, B and C).