Verruciform xanthoma developing in recessive dystrophic epidermolysis bullosa: A sheep in wolf's clothing.

[dystrophic epidermolysis bullosa]

A 23 -year -old male affected of recessive dystrophic epidermolysis bullosa presented with a 2 -month history of a growing verrucous plaque on the right flank . The clinical features and evolution suggested the diagnosis of cutaneous squamous cell carcinoma . Histopathological examination showed hyperkeratosis , parakeratossis , and verrucous acanthosis and numerous large xanthoma cells in the papillary dermis . Reflectance confocal microscopy disclosed the absence of epidermal atypia and the presence of aggregates of reflecting cells at dermal-epidermal junction and upper dermis . These cells were ultrastructurally characterized and corresponded to foamy histiocytes . Verruciform xanthoma is a benign reactive lesion that has occasionally been reported to develop in chronically eroded areas in patients with recessive dystrophic epidermolysis bullosa . In this group of patients , verruciform xanthoma may clinically mimic cutaneous squamous cell carcinoma and a correct diagnosis is crucial to avoid inappropriate aggressive therapeutic approaches . In vivo noninvasive image technologies such as reflectance confocal microscopy may be helpful diagnostic tools in this clinical setting .

Diseases
Validation

Diseases presenting "right flank" symptom

dystrophic epidermolysis bullosa

liposarcoma

scrub typhus

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