Wednesday, July 13, 2016

Annular Lesions in a 50 yo woman

This image was sent by Dr. Yogesh Jain from India for diagnostic suggestions.
The only history provided was that the process is present on the hands and feet and has been ongoing for 25 years. The lesions regress after a number of months.

Other than a variant of granuloma annulare or elastosis perforans serpiginosa, what are your thoughts?

Biopsy is important but so is the dermatopathologist who reads it.


  1. just to expand the differential...plaque type psoriasis with escale only on the borders or SCLE

  2. I think this is a variant of porokeratosis. I saw a discussion about it on the Indian dermatology Facebook page. I will look up some more information.

  3. from Emily Altman: "Porokeratosis, leprosy (some of our Indian colleagues say this is differential diagnosis #1 always :)), psoriasis. Then way way down the list granuloma annulare, lichen planus."

  4. from Khalifa Sharquie, Baghdad, This is very interesting case.I have seen a similar patient who has chronic recurrent lesions that start as papules and nodules over both shins that over time enlarge and become annular and then resolve spontaneously leaving hyperpigmented patches.This 30yrs old male patient has this process for 7yrs.The biopsy of new lesion showed a typical picture of keratoacanthoma.
    I called this condition as Chronic recurrent keratoacanthoma .These lesions were treated with 25%podophyllin which responded very well as podophyllin has been reported to be effective in patients with keratoacanthoma by Sharquie etal.

  5. AnonymousJuly 14, 2016

    Porokeratosis of Mibelli. But I will still need to exclude borderline leprosy. check for sensory loss and thickened nerves. Skin biopsy.

    Henry Foong


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