Lichen planus actinicus (LPA), or pigmentosus, or subtropicus occurs mainly in Middle Eastern countries, where between 20% and 30% of lichen planus cases are of this type. It tends to be more common in young adults of both sexes. The lesions develop in spring and summer on sun-exposed areas, especially the face. Three different forms have been described: annular (the most common type), pigmented (melasma-like), and dyschromic. The lesions are typically annular plaques with central slate blue to light brown pigmentation and well-defined, slightly raised, hypopigmented borders. Pruritus is minimal or absent and usually there is no oral mucous membrane involvement. The presented woman has melasma-like LPA involving mainly the butterfly area of the face of many months duration.
A teenager presented with a slightly itchy, blotchy, reddish brown scaly patches and plaques mainly on the trunk of a sudden onset at the start of summer.Pityriasis versicoloris a chronic, often symptom-free or only slightly itchy fungal infection characterized by pigmentary changes. It is caused by overgrowth of the mycelial form of the commensal yeast Pityrosporum orbiculareand is particularly common in humid or tropical conditions. PV mainly affects young adults, appearing on the trunk, neck and proximal parts of the limbs and presents as brown, pink or hypopigmented oval or round scaly patches covered with branny scaling.
Painless deep dermal and subcutaneous nodules and plaques involving the right cheek of this lady caused unilateral facial atrophy with cup-like depression (sunken cheek) of 12 years duration. At presentation, two new dermal nodules beneath normal skin were found in the lower part of the affected area. These nodules were firm, rubbery and non tender. A deep skin biopsy was taken from one of the new nodules has showed lymphocytic panniculitis with sharply circumscribed lymphocytic nodules in the lower dermis and subcutaneous fat. Serological investigations were normal apart from raised ESR and positive ANF.
Pilomatricoma (Pilomatrixoma or Calcifying Epithelioma of Malherbe) is a benign tumour derived from the hair matrix cells. It usually presents as an asymptomatic, solitary, deep seated, firm subcutaneous nodule with normal or pinkish above skin. The overlying skin on stretching produces the “tent sign” with multiple facets and angles. Commonest sites are the face, neck or arms; however, the scalp, trunk and lower extremities may be involved. At times, pilomatricoma may have a bullous appearance as in the current case of a female presented with a large bullous lesion with positive transillumination on upper arm of six months duration. The tumour has been excised totally and sent for HP which revealed an encapsulated mass composed of solid masses of basophilic cells and eosinophilic shadow cells.
A 26-year-old primigravida woman in her third trimester presented with severely pruritic erythematous papules involving mainly the abdomen and also the extremities of two weeks duration. The rash has started at the umbilical region and spread to other areas.
A 44-year-old healthy woman presented with a single hard nodule at the base of the right fourth finger of three years duration. A slight flexion deformity of the ring finger started to develop at last three months.
A 4-year old girl presented with multiple ecchymotic lesions of varying sizes involving the forehead, arms and legs of two weeks duration. Her mother said that one week before the onset of the condition her daughter suffered a febrile disease lasted about 5 days. There was no history of bleeding from any part of the body and negative drug history before purpuric manifestations. Family history of bleeding tendency also was negative. On investigations the CBC was normal apart from reduced platelets count which was 60000/mm3. Bone marrow examination showed normal megakaryocytes no. and morphology.
A 55-year old man presented with a painful keratotic papule on the helix of the ear of 6 months duration. It has been excised under local anesthetic. Histologically was consistent with Chondrodermatitis nodularis helicis.
