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2007:73:1;66-66
doi: 10.4103/0378-6323.30666

Widespread induration of the skin

Vandana Mehta Rai, C Balachandran
 Department of Skin and STD, Kasturba Medical College, Manipal, India

Correspondence Address:
Vandana Mehta Rai
Department of Skin and STD, Kasturba Medical College, Manipal-576 104, Karnataka
India
How to cite this article:
Rai VM, Balachandran C. Widespread induration of the skin. Indian J Dermatol Venereol Leprol 2007;73:66
Copyright: (C)2007 Indian Journal of Dermatology, Venereology, and Leprology
Homogenisation of collagen bundles in the dermis (100x)
Homogenisation of collagen bundles in the dermis (100x)
Basal cell degeneration (400x)
Basal cell degeneration (400x)
Hypopigmented macules on the back
Hypopigmented macules on the back
Thinning of the epidermis with follicular plugging, scanty dermal infiltrate with homogenisation of collagen in the dermis (x50)
Thinning of the epidermis with follicular plugging, scanty dermal infiltrate with homogenisation of collagen in the dermis (x50)
Multiple hypopigmented macules on the chest along with an ulcer on the right forearm overlying the hypopigmented plaque
Multiple hypopigmented macules on the chest along with an ulcer on the right forearm overlying the hypopigmented plaque

A 63-year-old male farmer presented with thickening and whitish discoloration of skin of the arms, forearms, upper chest and back of six months duration. Complaints started with itching over the right arm, which over a period of time became indurated. Skin tightness soon progressed to involve both upper limbs, chest and the back. At the same time the patient also gave history of multiple asymptomatic hypopigmented papules which coalesced to form atrophic plaques over the upper chest, forearms and back. There was no history of fever, joint pain, insect bites, circumcision, drug intake prior to the onset of lesions. There was no history of similar skin tightness over the face, hands or any other systemic complaints. Cutaneous examination revealed widespread induration of the skin of the upper back, chest, arms and both forearms. The skin of the right forearm appeared shiny because of induration [Figure - 1],[Figure - 2],[Figure - 3],[Figure - 4],[Figure - 5]. The lower limbs and face were not affected.

Multiple hypopigmented atrophic papules and plaques were seen on the back, chest and arms. Hypopigmented plaques with prominent follicular plugging were seen on the right arm. Palms, soles, nails and genitalia showed no abnormality. Systemic examination was normal. All the routine hematological and biochemical parameters were normal. The antinuclear antibody (ANA) profile showed a weak positive reaction to Sm and SS-A antibodies. Findings of the skin biopsy done from the indurated lesion on the right arm are shown in [Figure 6],[Figure 7],[Figure 8],[Figure 9]. A biopsy performed from the shiny lesion on the right forearm showed flattened epidermis with homogenization of the dermal collagen and a patchy perivascular infiltrate in the dermis.

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