History:

Case from Dr Kyaw Thet Naing

51-year-old male,Farmer rash on arm and face for 2 months he develop erythematous plaque at arm after contact with the rubber from the trees and then spread to face. The lesion is mild itchy, not tender and aggravated by sunlight. No history of previous trauma at the side of lesion. He denied history of significant weight loss or loss of appetite. He had no fever, no hair loss, no oral ulcer, no arthralgia.

Results KOH at Lt arm no fungus found

Gram stain at Lt arm Few PMN Gram positive cocci : few Gram negative bacilli : few

Aerobic culture at Lt arm Staphylococcus aureus

Histopathology Section display slightly acanthosis epidermis with hypergranulosis. There is a distinct change with lymphocytes. The dermis show superficial and mid perivascular lymphoplasmacytic infiltration. Mucin deposit is noted in the dermis interstitium. Histological diagnosis : Hypertrophic lupus erythematosus Direct immunofluorescence IgG : negative IgM : positive at colloid body C3 : positive at colloid body Fibrinogen : positive at Dermal-epidermal junction

Treatment Hydroxychloroquine(200) 1 tab oral bid pc Interlesional corticosteriod 10 mg/ml 10% urea in 0.1% betamethasone apply lesion at body bid -30 g 0.05% betamethasone apply lesion at face bid – 15 g Oral antihistamine Follow up CBC, LFT every 4-6 months Ocular examination every 6 months