Abstract
A 63-year-old woman presented with scattered individual milia-like cysts and multiple brown-violaceous plaques with multiple confluent white-yellow cysts on their surface. The lesions involved the right side of the forehead and neck, right cheek, temporal, and preauricular area (Fig. 1A).
In addition, areas of scarring alopecia were evident on the scalp (Fig. 2B). According to the patient, the alopecia developed 7 years ago, and 4 years later, the plaques with cysts atop occurred and progressed slowly.
The patient did not have any treatment for the cutaneous lesions and had no relevant medical history. The patient denied any signs of photosensitivity.
A laboratory work-up including blood cell count, biochemistry, serum proteins, immunoglobulins, complement, thyroid metabolism, syphilis serology, antinuclear antibodies, anti-Sm, anti-ribonucleoprotein antibodies, anti-Ro (SS-A) antibodies, anti-La (SS-B) antibodies, anti-double stranded (ds)-DNA, rheumatoid factor, and erythrocyte sedimentation rate revealed no abnormality. A biopsy of the face plaque revealed a slightly atrophic epidermis overlying numerous, partly confluent infundibular cysts filled with orthokeratotic material (Fig. 2A).
These cysts and hair follicles were surrounded by a dense band-like lichenoid lymphoid infiltrate (Fig. 2B), composed predominantly of CD8-positive lymphocytes. CD4+ cells were less conspicuous, with the CD4:CD8 ratio of 1:3.
CD20+ B-cells formed small clusters. Rare CD123+ plasmacytoid dendritic cells were scattered in the infiltrate.
There were some colloid bodies in the dermoepidermal junction. The patient refused any treatment.