Acta Dermato-Venereologica 99-10CompleteContent | Page 34

937 Hyperpigmented Plaque on a Farmer’s Nose: A Quiz Wei LIU 1 , Jin-Yuan MA 2 and Dong-Lai MA 1 * 1 Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, and 2 Preventive Medicine, School of Public Health, Southern Medical University, Guangzhou, China. E-mail: [email protected] A 66-year-old man presented with a 1-year history of asymp- tomatic hyperpigmented plaque on his apex nasi. The lesion initially appeared as erythematous macules, and several open, black comedones gradually developed. The patient was a farmer and had worked outdoors for more than 40 years without sun protection, which resulted in substantial sun exposure. He also had smoked >10 cigarettes daily for more than 40 years. On physical examination, a 1.5×2-cm hyperpigmented plaque was located on the apex nasi; it showed symmetrical distribution of multiple open, black comedones (Fig. 1A). Wrinkles and furrows were present on the patient’s forehead. The remainder of his physical exa- mination was unremarkable. Laboratory tests were negative, including complete blood count, antinuclear antibodies, and dsDNA antibodies. A lesional punch biopsy showed epider- mal atrophy, solar elastosis, and multiple dilated follicular infundibula filled with laminated keratinous material (Fig. 1B). Focal elastosis and degeneration of elastic fibres were observed in the dermis (Fig. 1C). What is your diagnosis? See next page for answer. Fig. 1. (A) Clinical image. A hyperpigmented plaque with multiple open, black comedones on the apex nasi. (B) Histopathological image. A lesional punch biopsy showed epidermal atrophy, solar elastosis, and multiple dilated follicular infundibula filled with laminated keratinous material (haematoxylin- eosin staining ×40). (C) Special stain image. Focal elastosis and degeneration of elastic fibres were observed in the dermis (elastic fibre staining ×40). QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3236 Acta Derm Venereol 2019; 99: 937–938