Degos' disease

A 47-year-old woman presented with slightly pruritic, burning lesions on her submammary area and legs of 3.5 years' duration. Similar lesions had appeared on her arms and feet. She was hospitalized at the Pulmonary Diseases Hospital, Izmir, with a complaint of thoracic pain, and was diagnosed with nonspecific pleuritis by pulmonary X-ray, thoracic computed tomography (CT) scanning, bacterial cultures of phlegm, and pleural biopsy examination. Fifteen days after leaving hospital, she was admitted to the Surgical Clinic of Ataturk Training Hospital, Izmir, with a complaint of severe abdominal pain, and diagnosed with nonspecific peritonitis. On dermatologic examination, she had multiple, scattered papules (2-3 mm in diameter), with a typical, central, white, porcelain-like zone of atrophy, on the trunk (Fig. 1), legs (Fig. 2), and arms. The lesions were encircled by a slightly raised erythematous border. Some of the lesions had coalesced giving polycyclic atrophic areas and ulcerations. Histopathologic examination of the skin biopsy specimen showed hyperkeratosis, epidermal atrophy, dermo-epidermal separation, edema, and necrosis in the papillary dermis (Fig. 3). Fibrinoid necrosis and thrombosis were seen in the papillary dermis and in the vessels below the lesions. The patient was diagnosed with Degos' disease from these clinical and histopathologic findings. She was treated with anti-inflammatory drugs. One year later, the patient was hospitalized at the Department of Internal Medicine of Ataturk Training Hospital, Izmir, with a diagnosis of pericarditis and pleuritis.