A rare clinical image: Papillomatosis cutis lymphostatica in a black patient

Abstract

Patient is a 53 year-old black woman with a history of type 2 DM, HTN, R knee total arthroplasty, and significant obesity. She has been suffering with chronic lymphedema for several years and is presenting today with papillomatosis cutis lymphostatica with overlying cellulitis to the right lower extremity (Figures 1,2). Supporting clinical features in this patient include common features such as shiny, smooth, pearl-like, hyperkeratotic papules that are either flesh toned or hyperpigmented, positive stemmer sign, and hyperkeratotic hyperpigmented skin [1]. At this stage of pathology, edema is no longer pitting in nature. Papules range in size from 0.5 to 1 cm and are predominantly dome-shaped or occasionally scalloped (Figure 3). Today, She did have overlying erythema and discomfort upon exam due to the concurrent cellulitis, but does not typically experience pain related to the lesions. Risk factors for this patient include history of poorly controlled type [2] diabetes mellitus, right total knee replacement and varicose veins in bilateral lower extremities [1].