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September 20, 2010

Pruritic Indurated Plaques on the Legs of a 62-Year-Old Woman—Quiz Case

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Arch Dermatol. 2011;147(1):109-114. doi:10.1001/archdermatol.2010.401-a

A 62-year-old white woman presented with a 1-year history of painful pruritic skin lesions on her thighs. On physical examination, there were tan to violaceous indurated plaques in an arcuate pattern on her bilateral thighs (Figure 1). An initial biopsy specimen revealed dermal sclerosis and rare plasma cells without subcutaneous tissue for evaluation. Presumptive morphea was treated with intralesional triamcinolone and clobetasol ointment applications, without improvement. A second wedge biopsy specimen was obtained for histologic evaluation (Figure 2 and Figure 3; hematoxylin-eosin, original magnification ×4 and ×40, respectively). Laboratory results were negative for factor V Leiden, cryoglobulins, and anticardiolipin antibodies. Peripheral blood analysis revealed elevated hemoglobin (20.7 g/dL) and hematocrit (61.1%) levels and red blood cell (7.5 ×106/μL) and platelet (542 ×103/μL) counts.

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