Resident Dermatologist: Sabrina Shearer,MD

Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

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?

  1. Plaque Psoriasis
  2. Lichen Planus
  3. Nummular eczema
  4. Secondary Syphilis
Lichen Planus