Khaled El-Hoshy MD, Dermatologist, Livonia, MI, USA on January 23, 2011
I would manage as pigmented purpuric eruption, with a f/u visit bi-annually. Re-biopsy in the future, should circumstances change.
Jerome Litt MD, Dermatologist, Beachwood, Ohio, USA on Jamuary 23, 2011
Rule out drug eruption. How about a list of drugs?
Robert Rudolph MD, Clinical Professor of Dermatology, University of Pennsylvania, Philadelphia, PA, USA on January 23, 2011.
With that biopsy I'd be concerned about an incipient MF.
Surely doesn't look like a pigmented purpura to me (even the lichenoid type found on legs), a FDE (my first thought at glancing at the photo), or true lichen planus.
I'd repeat the biopsies and perform "stains for MF cell types" from both sites.
Bhushan Kumar MD, Consultant Dermatologist, Chandigarh, India on January 23, 2011
Could it be lichen aureus?
Nasser Altamimi MD, Dermatologist, Sana, Yemen on January 23, 2011
How about Lichen sclerosus? this is very common in menopausal women
Bashir Zendah MD, Senior Registrar, Department of Dermatology, Tripoli Medical Centre Tripoli, Libya on January 27, 2011
Lichenoid purpura is the first possibility with this picture but she need further follow up and re-biopsy to exclude M F changes later on.
Julian Manzur M.D., Dermatologist, Havana, Cuba on February 6, 2011
My first diagnosis is Fixed drug eruption.
Neil Shah MD, Dermatologist, Mayo Clinic Rochester, USA on February 22, 2011
Interesting case. I could see lichenoid PPD with the closeup photo you show. Arguing against LSA would be lack of gross architectural distortion (were the labia minora structurally normal?). Would follow clinically for progression if a question of CTCL. Photomics don't look good for CTCL at this point, but look good for PPD.
PPDs respond fairly rapidly to rutin + vitamin C. (J Am Acad Dermatol. 1999 Aug;41(2 Pt 1:207-8). I've had success with a product called Hy-Bio (available on Amazon.com) which contains rutosides and vitamin C. Usually complete resolution within 14-28 days. In this case useful as a therapeutic and diagnostic maneuver.