Sclerotic Plaques

Abstract

The differential diagnosis of sclerotic plaques includes morphea, lichen sclerosis, early atrophoderma, chronic radiation dermatitis, scleromyxedema, and nephrogenic systemic fibrosis. Scleroderma and scleredema are excluded due to the diffuse nature of the sclerosis.

Morphea is characterized by reticular dermal sclerosis with a superficial and deep perivascular and interstitial lymphocytes. Lichen sclerosis reveals papillary dermal edema followed by sclerosis, and a perivascular almost band-like infiltrate at the junction between the papillary dermis and the uninvolved reticular dermis. The histological findings of atrophoderma can be missed. Chronic radiation dermatitis is striking in the variability of findings in the same specimen. Scleromyxedema and NSF reveal proliferation of fibroblasts and excessive interstitial mucin in addition to collagen thickening.