Necrobiosis lipoidica: irregularly configured, sharply defined, plate-like, atrophic, "scleroderma-like", smooth plaques. brownish-yellow sunken centre with atrophy of skin and fatty tissue. reddish-violet to brownish-red rim.
Fasciitis, necrotizing. foot of a 53-year-old patient. after a banal traumatic injury to the inner ankle, a fulminant, highly painful, doughy swelling developed within 3 days with diffuse redness of the entire lower leg. extensive necrosis of the skin of the inner ankle and over the edge of the tibia. fluctuating swelling in the middle of the lower leg. here incision with evacuation of about 50 ml of purulent secretion.
erythema induratum. solitary, chronically stationary, 4.0 x 3.0 cm in size, only imperceptibly growing, firm, moderately painful, reddish-brown, flatly raised, rough, scaly nodules with a deep-seated part (iceberg phenomenon). intermediate painful ulcer formation (Fig). no evidence of mycobacteriosis.
Lymphedema: one-sided, skin-coloured swelling due to insufficient transport capacity of the lymphatic vessel system; swelling of the toes and back of the foot (Stemmersches sign: positive).
Pemphigus vulgaris:multiple, chronic, since 3 years intermittent, symmetric, trunk accentuated, easily injured, flaccid, 0,2-3,0 cm large, red blisters, which confluent to larger, weeping and crusty areas, here infestation of the hollow of the knee.
Bowen's disease with transition to Bowen's carcinoma: solitary, size-progressive plaque that has been present for several years, occasionally accompanied by itching, sharply and arc-shaped, border-emphasized plaque with increasing verrucous nodular formation (see following figure).
Lipogranulomatosis subcutanea: Pressure pain-sensitive, subcutaneously situated, walnut-sized nodules with livid discoloration and superficial skin peeling on the inner side of the lower leg in a 59-year-old woman.
Leishmaniasis, cutaneous. solitary, chronically dynamic, since 6 months slowly growing, 1.5 x 2.0 cm in size, firm, slightly scaly, brown, rough, flatly elevated lump with central ulceration. anamnestic journey to an endemic area (vacation in Mexico).
Vasculitis, leukocytoclastic (non-IgA-associated). multiple, acute, symmetric, localized on both lower legs for 1 week, irregularly distributed, 0.1-0.2 cm large, sharply defined, symptomless, red, smooth patches (non-compressible). Occurrence after flu-like infection and ingestion of a non-steroidal anti-inflammatory.
Necrobiosis lipoidica: 44-year-old woman. 10 years ago, fracture of the ankle joint with surgical treatment, for about 8 years beginning changes in the scars on the inner and outer ankle. Histologically, a necrobiosis lipoidica could be confirmed. On request, she was under constant diabetological control, since both previous pregnancies had been accompanied by insulin-dependent gestational diabetes.
Squamous cell carcinoma of the skin: chronically persistent, for several years existing, slowly progressing in size, weeping and bleeding for 12 months, rough, red, rough, crusty plaque on the right forearm of an 85-year-old patient. Before histological confirmation of the correct diagnosis, the disease was misdiagnosed as psoriasis and fungal disease by several practitioners due to the unusual localization.
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