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A 54-year-old female presented with multiple erythematous painful lesions across her lower legs, buttocks, and trunk that she thought were inflamed insect bites. She continues to develop new lesions every month, and they ulcerate and then heal with scarring. She has no systemic symptoms and had not been prescribed any regular medication. Examination revealed multiple fully developed lesions characterized by an atrophic, porcelain white scar surrounded by an erythematous and telangiectatic rim (Figure 1). Findings from her complete blood cell count and renal and liver function tests were within reference range. Her C-reactive protein level was raised at 56 mg/L (reference range, <5 mg/L). (To convert C-reaction protein to nanomoles per liter, multiply by 9.524.) Levels of antinuclear and anticardiolipin antibodies IgG and IgM were also within reference range. A skin biopsy was performed from a sample taken from her right lower leg (Figure 2 and Figure 3).
DeGiovanni CV, Russell-Jones R, Coburn P. Atrophic Scars in a 54-Year-Old Woman—Quiz Case. Arch Dermatol. 2009;145(3):321–326. doi:10.1001/archdermatol.2008.627-a
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