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November 2009

Asymptomatic Nodules on the Foot—Diagnosis

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Arch Dermatol. 2009;145(11):1325-1330. doi:10.1001/archdermatol.2009.254-b

At low power (Figure 2), the skin biopsy specimen shows striking surface lichenification with a thickened keratin layer and regular acanthosis. There is also a markedly thickened dermis. At higher power, in the reticular dermis (Figure 3), hypertrophic collagen bundles are seen. There is no cellular infiltrate. An elastic van Gieson stain (not shown) revealed a slight relative reduction in elastic fibers owing to the collagen hypertrophy. Further questioning revealed that our patient worked as a supermarket shelf stacker, wore tight-fitting athletic sneakers, and spent a lot of time kneeling on the floor to access lower shelves. Wearing different shoes and using protective knee padding at work led to marked improvement, obviating the need for surgical intervention.

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