65 yr old male, otherwise healthy except for a mild hypertension treated with Diovan (valsartan) , in two months has developed plaques on the inferior aspects of both legs. Asymptomatic. Refers recent lab workout with normal results

Culture and  direct exam negative for fungus.

An experient dermatologist biopsied: ” Skin fragment with corneal layer showing ortokeratosis and epidermis of usual thickness, wth mild foci of spongiosis. Dermis shows mild superficial perivascular lymphocytic inflamatory infiltrate, with endothelial oedema and erythocyte extravasation, although there are no signs of vascular wall aggresion, like vascular fibrinoid necrosis. Additionally, no evidences of leucocytoclasis . Small hemosiderin deposits on the dermis.

Conclusion – superficial perivascular dermatitis with associated capillaritis. No histological signs to support the clinical hypothesis of Hansen’s Disease (unfortunately, still endemic in Brasil >: ) or Numular Eczema.”

Illustrious friends, what are your impressions and suggestions??

yours,
George Leal
Dermatologist
Fortaleza, Brasil