G Ruina

When the exception proves the rule: pityriasis rotunda of difficult classification

Pityriasis rotunda (PR) is a rare disorder of keratinization characterized by multiple, round, well-defined, scaly, hyperor hypopigmented patches with no inflammatory changes. Associations between PR and malignancies, systemic illnesses, and pregnancy have been described. We report an unusual case of PR that did not align with the recognized clinical and epidemiological patterns of the disease.

A verrucous and ulcerated lesion of the leg: challenge. Deep mycosis by Trichophyton species.

CASE REPORT An 83-year-old woman, in follow-up by a hematologist for a previous non-Hodgkin lymphoma, was admitted to our Department of Dermatology for an 8-month history of verrucous and ulcerated lesion on her left ankle. She referred that the cutaneous lesion had appeared after trauma caused by wood scraps. Despite treatment with an oral antibiotic and topical antibiotic/corticosteroids, the ulcer progressively enlarged. Skin examination showed an ulcer of 5.3 · 6.4 cm of diameter covered by serous–hematic crusts and surrounded by erythematous– atrophic skin. The lesion was located on the posterior–medial surface of her left ankle (Fig. 1). The histological examination showed granulomatous exocytosis and pseudoepitheliomatous hyperplasia in the epidermal layer and an inflammatory granulomatous dermal infiltrate (Figs. 2, 3). Laboratory investigations including complete blood count, urine analysis, liver and renal function tests, paraneoplastic markers (CA125, CA15-3, CA19-9, CEA, alfa fetoprotein), complement, and immunoglobulin levels were normal. Quantiferon-TB Gold test, HbsAg and anti-HCV antibodies were negative. Only an increase of antinuclear (1:320) and antineutrophil cytoplasmic antibodies titer (6.9 U/mL) and a diminished CD4/CD8 ratio (0.87) were observed. Chest X-ray and abdominal ultrasonic examination showed no abnormalities. The complete healing of the lesion was obtained after treatment.