An 80-year-old woman presented with a 9-week history of multiple nonpruritic, red, shiny, dome-shaped lesions mainly affecting the arms and thighs (Fig. 1). A few lesions were present on the lower back and a single one on the scalp. The patientÕs medical history included hypertension, diabetes, appendicectomy, incisional hernia, cataracts, and myopic degeneration in both eyes. erythrocyte sedimentation rate was moderately raised at 41 mm ⁄ h, but apart from a slightly elevated alkaline phosphatase result, all other investigations were normal.
Histopathological findingsSkin biopsy of one of the papular lesions showed a normal epidermis; the dermis contained an infiltrate of macrophages with abundant eosinophilic cytoplasm and large monomorphic oval nuclei. These cells showed immunopositivity for factor XIIIa and CD68, but were negative for S100. Scattered lymphocytes and occasional plasma cells were also seen (Fig. 2a-c).What is your diagnosis? C P D Figure 1 Multiple erythematous, shiny, dome-shaped skin lesions on the thigh.