Acta Dermato-Venereologica 99-6CompleteContent | Page 30

629 Ulcers and Scars on the Trunk of a 20-month-old Boy: A Quiz Tal GOLDBERGER 1 , Alexander MALY 2 , Tamar HAREL 3 and Vered MOLHO-PESSACH 1 * Departments of 1 Dermatology, 2 Pathology, and 3 Human Genetics, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 9112001, Israel. *E-mail: [email protected] A 20-month-old boy was brought for examination due to numerous ulcers over his upper trunk, of 6 months duration. He was a single child to first-degree cousins of Arab Pales- tinian descent. The parents denied any trauma preceding the appearance of the ulcers. Treatment with emollients, topical corticosteroids and topical antibiotics had not resulted in clinical improvement. The child had history of neonatal stridor and chronic hoarseness, but was otherwise healthy. Fiber optic laryngoscopy did not reveal any structural ab- normalities in the vocal cords or larynx. Physical examination revealed numerous symmetrically distributed, round-oval, punched-out ulcers, as well as depressed erythematous and skin-coloured scars on the mid- and upper back, shoulders and thorax (Fig. 1A). Thin hair and dry skin were also noted. A 3-mm punch biopsy was obtained from a lesion on the left shoulder. Histopathological evaluation demonstrated a hyper- trophic scar, composed mainly of fibroblasts and myofi- broblasts (which stained positively for actin), as well as a Periodic acid–Schiff (PAS)-positive hyaline thickening of a capillary wall in the superficial dermis (Fig. 1B). What is your diagnosis? See next page for answer. Fig. 1. (A) Multiple symmetrically distributed, round- oval, depressed scars on the back of a 20-month-old boy. (B) Histopathological examination of a skin biopsy specimen (haematoxylin-eosin, original magnification ×600) showing Periodic acid–Schiff (PAS)-positive hyaline material around small blood vessels (arrows) in the superficial dermis. 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: 10.2340/00015555-3153 Acta Derm Venereol 2019; 99: 629–630