A 46-year-old woman presented with the new onset of a slightly stinging and burning, expanding patch on the upper abdominal skin. The patient was otherwise entirely healthy and ingesting no medications.
Key point: The lesion consists of a solitary, fairly well-defined whitish-colored plaque, surrounded by a broad band of violaceous erythema. The area was not tender to the touch, but did feel firm to palpation. This is a classic presentation for the “lilac ring” phase of early morphea.
Treatment: Application of potent topical steroids led to the prompt resolution of inflammation and to cessation of lesional expansion. Ultimately, the patient was left with a somewhat hard, slightly hypopigmented patch with a faint brown border, representing “burned out” (or inactive) morphea.
Note: This is a manifestation of localized scleroderma and is typically not associated with systemic signs or symptoms.
A hematologically stable CML patient developed a solitary, exquisitely painful ulceration, 7 cm × 5 cm, located on the mid-medial foreleg. There was never any evidence of venous insufficiency. The patient denied the possibility of a spider bite. What is the likely cause of this lesion?
