Expert: Neha Dahiya MD - 8/19/2009

Question
Dr. Dahiya,

I have had an ongoing rash for about 5-6 years. It is in the crease of my leg (at panty line) and has spread to the labia(same side) and about an inch outward toward the leg. It has made the labia very wrinkled and loose. It started as a little bothersome, it would come and go, but the past several years it has really increased and become unbearably itchy. Almost on a constant basis. The skin is very dry and irritated and it has a very distinct border that changes from red to a purplish color. I have noticed several nodule like bumps also forming. REcently I had a biopsy done and this is the report:

Punch biopsy .3x.3x.3

There are foci of ortho and parakeratosis over an acanthotic epidermis. The papillary dermis is thickened and contains a moderately dense lymphohisyiocytic infiltrate. The etiology of the dermatitis cannot be determined on a histologic basis. The lesion is lichenified. The PAS stain for fungus is negative.

Note: The lesion is excoriated. Multiple deeper cuts were done.

Diagnosis: Chronic dermatitis, lichenified. PAS is negative.

Does this sound like a thorough enough report. The reason I ask is because I have not been feeling well for sometime and can't get to the root of it. I know it is rare but could a skin lymphoma be ruled out? I have read they can be hard to diagnose and special stains should be done.

What are your thoughts?

Thanks,
Tammy

Answer
Hello Tammy:

I apologize for the delay in answering, due to unforeseen circumstances I was unable to attend to your question.

It is difficult to comment on what the diagnosis is unless one sees the slide.

However going by the information in the report it appears to fit in with dermatitis. This is a response of skin to some form of allergen or irritant. This has to be ascertained to help cure the condition.
I hope this answers your question to some extent.

If there was suspicion of lymphoma the pathologist would mention that and do other stains