HISTORY:
37 y/o AAF with a history of mild eczema and a remote history of syphilis (treated at the time of infection with IM penicillin) presents with itchy rash on her arms and trunk for 3 months. She has been treated with triamcinolone cream with no improvement.
At low magnification, there is epidermal hyperplasia with a prominent granular cell layer (hypergranulosis). Much of the dermal-epidermal junction is obscured by a band-like infiltrate of lymphocytes.
The rete pegs are elongated with jagged tips, known as “saw-tooth” or “ice pick” hyperplasia. A few necrotic keratinocytes (i.e. colloid bodies) are present along the dermal-epidermal junction (arrow).
High magnification reveals numerous necrotic keratinocytes along the dermal-epidermal junction (“colloid bodies”).
What is the most likely diagnosis?
- Plaque Psoriasis
- Lichen Planus
- Nummular eczema
- Secondary Syphilis