Ichthyosiform red-brown plaques on bilateral shins

Abstract

A 58-year old African-American woman presented with a 3-year history of scaly plaques on her legs. Prior treatment consisted of triamcinolone cream and compression stockings. Examination found thin, red-brown rhomboidal plaques with adherent scale on anterior legs bilaterally (Fig 1) and no other skin involvement. Review of systems was positive for chronic dyspnea on exertion. Tuberculin test was negative. A punch biopsy found numerous deep dermal noncaseating granulomas composed of epithelioid cells and giant cells surrounded by a pauci-cellular cuff of lymphocytes (Fig 2).