Indian Journal of Dermatology
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Year : 2013  |  Volume : 58  |  Issue : 2  |  Page : 155-156
Widespread confluent, annular, and circinate patches and plaques in a 56-years-old woman


1 Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada e Tajrish Hospital, Tehran, Iran
2 Department of Pathology, Danesh laboratory, Tehran, Iran

Date of Web Publication5-Mar-2013

Correspondence Address:
Mohammad Shahidi-Dadras
Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada e Tajrish Hospital, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.108067

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How to cite this article:
Shahidi-Dadras M, Hejazi S, Ayatollahi A, Saeedi M, Asadi-Kani Z. Widespread confluent, annular, and circinate patches and plaques in a 56-years-old woman. Indian J Dermatol 2013;58:155-6

How to cite this URL:
Shahidi-Dadras M, Hejazi S, Ayatollahi A, Saeedi M, Asadi-Kani Z. Widespread confluent, annular, and circinate patches and plaques in a 56-years-old woman. Indian J Dermatol [serial online] 2013 [cited 2019 Oct 18];58:155-6. Available from: http://www.e-ijd.org/text.asp?2013/58/2/155/108067


A 56-year-old female presented with 1-year history of pruritic, extensive skin eruption. The lesions tend to wax and wane in severity. The onset was from dorsal aspect of her right foot. Extremities, lower abdomen, buttocks, and intertriginous areas then involved. Different topical treatments were used with no significant improvement. She had experienced a weight loss (30 kg in 2 years). She had a 6-year history of normocytic normochromic anemia with unknown etiology. Also, she had an adult-onset diabetes mellitus (DM) since 12 years ago. Her family history was positive for hypertension (HTN) and DM in her first-degree relatives. Physical examination showed an anemic patient with bilateral angular cheilitis, glossitis [Figure 1], and nail changes (nail color change, brittleness, onycholysis, nail striations) [Figure 2]. Widespread scaly, eroded, confluent, annular and circinate patches and plaques, some as large as 15 cm in diameter, with superficial bulla and necrosis were seen [Figure 3]. She had no detectable organomegaly. Occular, oral, and genital mucosa were intact. Routine lab tests revealed mild thrombocytopenia, normocytic normochromic anemia, and hyperglycemia. A skin punch biopsy was performed from an active lesion on her left leg.

The microscopic study revealed a psoriasiform acanthosis, prominent and confluent necrosis of the upper layer of stratum spinosum with neutrophilic exocytosis. Furthermore, mild epidermal hyperplasia, vacuolar change, and deficient granular layer were noted. Perivascular lymphocytic infiltration and scattered extravasated RBCs were in the upper dermis [Figure 4].
Figure 1: Bilateral angular cheilitis and glossitis

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Figure 2: Nail changes

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Figure 3: Confluent, scaly annular patches, and plaques

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Figure 4: Psoriasiform acanthosis, epidermal necrosis, vacuolar change, perivascular lymphocytic infiltration

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   References Top

1.Lobo I, Carvalho A, Amaral C, Machado S, Carvalho R. Report glucagonoma syndrome and necrolytic migratory erythema. Int J Dermatol 2010;4:24-9.  Back to cited text no. 1
    
2.Alkemade JA, Tongeren JH, Haelst UJ, Smals A, Steijlen PM, Kerkhof PC. Delayed diagnosis of glucagonoma syndrome. Clin Exp Dermatol 1999;24:455-7.  Back to cited text no. 2
    
3.Chastain MA. The glucagonoma syndrome: A review of its features and discussion of new perspectives. Am J Med Sci 2001;321:306-20.  Back to cited text no. 3
    
4.Pujol RM, Wang E, el-Azhary RA, Su WP, Gibson LE, Schroeter AL. Necrolytic migratory erythema: Clinicopathologic study of 13 cases. Int J Dermatol 2004;43:12-8.  Back to cited text no. 4
    
5.Prinz RA, Dorsch TR, Lawrence AM. Clinical aspects of glucagon-producing islet cell tumors. Am J Gastroenterol 1981;76:125-31.  Back to cited text no. 5
    
6.Wermers RA, Fatourechi V, Wynne AG, Kvols LK, Lloyd RV. The glucagonoma syndrome. Clinical and pathologic features in 21 patients. Medicine (Baltimore) 1996;75:53-63.  Back to cited text no. 6
    
7.Lightman SL, Bloom SR. Cure of insulin-dependent diabetes mellitus by removal of glucagonoma. Br Med J 1974;1:367-8.  Back to cited text no. 7
    
8.Higgins GA, Recant L, Fischman AB. The glucagonoma syndrome: Surgically curable diabetes. Am J Surg 1979;137:142-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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