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JAMA Dermatology Clinicopathological Challenge
June 2017

Annular Plaques With Skin Atrophy in a Young Patient

Author Affiliations
  • 1Department of Dermatology, Peking University First Hospital, Beijing, China
  • 2Department of Dermatology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
JAMA Dermatol. 2017;153(6):595-596. doi:10.1001/jamadermatol.2016.5717

A young woman presented with multiple arciform to annular plaques on her extremities, favoring the antecubital and popliteal fossae (Figure, A). The patient reported that these asymptomatic lesions had been present since her adolescence, and she was easily bruised with minimal trauma since birth. There was no family history of similar cutaneous findings.

On close inspection, the plaques were found to be composed of individual 2- to 4-mm keratotic papules surrounding white atrophic patches. Physical examination also revealed remarkable skin atrophy on the dorsal aspects of her hands (Figure, B) and feet. The patient’s skin was generally pale and translucent with visible veins, especially on the chest and abdomen. The face appeared to be emaciated, with a pinched nose, thin lips, sunken cheeks, and prominent eyes. A punch biopsy specimen from an individual papule from the left arm was obtained and analyzed under Verhoeff–van Gieson stain (Figure, C).

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