Reticular Erythematous Mucinosis
This case brings together a variety of interesting clinical and histopathological features. The name of the disease perfectly describes both features.
There is nothing specific about a reticulated erythematous rash. It may be a primary skin disease or part of a systemic disorder. Classic diagnoses include:
Confluent and reticulated papillomatosis
Similarly, the histopathologic findings of a superficial and deep perivascular and periadnexal lymphocytic infiltrate with dermal mucinosis may be visualized with several dermatological disorders including:
Since the common link in these two categories is lupus erythematosus, it was critical to exclude this latter disease. In this current case, the patient's ANA was negative. A biopsy for direct immunofluorescence was not performed. It should be noted that some investigators do believe REM to be a variant of lupus.
This case illustrates the cooperative marriage between the clinical and histopathologic findings, to arrive at a diagnosis. Now, if only we could just transfer this harmony to humans!
Clinical photo and case history submitted by Elizabeth Lener, M.D., Ladera Ranch, CA.
First Posted March 30, 2006
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