Inflammatory skin conditions                  Dr Jon Oxley

Clinical Information

CASE LINK

Clinical:  Female aged 48. ?allergic contact dermatitis ?herpes. Specimen:  Biopsy left shoulder.  Macro: Skin shave 0.6x0.3cm

CASE 1

Clinical:  Female aged 44. Deep seated infection in right femur - on IV antibiotics for 7-10days. 2day history of an extensive confluent erythematous rash on face and flexures with pustulation and blistering. ?SJS/TEN/AGEP.
Specimen:  Incisional biopsy from chest
Macro:  An ellipse of skin 10x4mm with subcutaneous tissue to a depth of 5mm

CASE 2

Clinical: Known renal failure, diabetes and endometrial cancer
?calciphylaxis. Livedoid eruption with central eschar.
Specimen: Biopsy right thigh
 Macro: Skin ellipse 15x7x7mm with a flat brown lesion 6mm in diameter.

CASE 3

Clinical: Female aged 25 years. Itchy blue red plaques on thighs in cold
              weather. Horse rider.
Immunohistochemistry: Mixed CD4 and CD8 positive T cells.
Specimen: Skin
Macro: Ellipse of skin 12x3x5mm.

CASE 4

Clinical:  Female aged 64. Scaly rash lower legs.
Specimen: Incisional skin biopsy from right lower leg.
Macro: Scaly rash

CASE 5

Clinical: Female aged 58.  30 year history of hyperkeratotic plaques on the
          scalp and face ? Darier's disease.
Specimen: Skin biopsy.
Macro: Punch biopsy of skin 4 mm in diameter x 4 mm deep.

CASE 6

Clinical: Female aged 79.  Psoriasiform rash on trunk and limbs.
Specimen: Punch biopsy

CASE 7

Clinical: Female aged 61. Raised papular plaque, left back? G. Annulare
Specimen: Skin punch biopsy
Macro: 6mm punch biopsy

CASE 8

Clinical: Female age 43. ?erythema nodosum, front of right leg. O/E raised
          red nodules over shins. HIV positive. TB not proved on lymph node
          culture. Previous biopsy showed similar features. T-spot test positive
Specimen: Incisional biopsy
Macro: Strip of skin19x4mm with underlying tissue to a depth of 5mm

CASE 9

Clinical:  Female 65 yrs. Extending atrophic white plaque left
                                        anterior iliac region.
Specimen: Skin incisional biopsy, left anterior iliac region.
Macro: Elliptical piece of skin 20x6x6mm.

CASE 10

Clinical:  Male aged 60 years. Skin left popliteal fossa excision. Five week history of nodule on skin. No pus. Has some insect bites. ?insect bite reaction, ?keratoacanthoma versus SCC.
Specimen: Skin - popliteal fossa
Macro: Skin biopsy : 18x13x2mm in depth with a centrally raised slightly keatotic lesion 5mm in diameter.

CASE 11

Clinical: Female aged 29 years. 28 weeks pregnant. Pruritic papules on
abdomen and legs with vesicles in ring-like distribution around  two of the lesions. Immuno: Direct immunofluorescence shows linear C3 along basement membrane.
   Specimen: Skin biopsy right wrist

CASE 12

Clinical:  Pyrexia, dermal pustular infiltrate face, scalp and neck. ?Sweet's.
Specimen: Skin punch biopsy - scalp
Macro: 4mm punch biopsy all embedded

CASE 13

Clinical: Male aged 36 years. Pigmented patch left leg ?Lichen aureus. Perls' +ve.
Specimen: Punch bx skin - left leg
Macro: Punch biopsy 5mm in diameter x3mm deep. Bisected and embedded

CASE 14

Clinical:  Male aged 62 years. Warty pink nodule of a few years duration.
?Hypertrophic lichen planus ?Lichen simplex.
Specimen: Skin right calf
Macro: A piece of skin measuring 1.5x0.4x0.5cm.

CASE 15

Clinical:  Male aged 42, subcutaneous lumps on buttocks. Previous anabolic
           steriod injections at this site (body builder). Also increasing
           shortness of breath on exertion. Abnormal CXR and raised ACE.
 Specimen:  Incisional ellipse biopsy

CASE 16

Clinical:  Female aged 61 years. Purple erythematous patches with overlying
          scale and atrophy on extensor surfaces, buttocks, axilla, arm and breast. 

CASE 17

Clinical:  female aged 62. H/O multiple symmetrical flat topped violaceous
          macules. Assessed by dermatology and biopsy advised. ?Lichenoid
          or granulomatous change. Possibly morphoea.

CASE 18

Clinical: Lesion on neck ?SCC

CASE 19

Clinical:  Male aged 73 years.  Diabetes and chronic renal failure.  Generalised pruritus. Papular lesions on limbs, many crusted with central keratin plugs.
Specimen: Skin punch biopsy, left upper arm.
Macro: skin punch biopsy with dark crust on surface.

CASE 20