The Curious Case of an Elusive Solitary Plaque

A 60-year-old male patient presented with a solitary pink plaque over the inner aspect of the left forearm of 4 years duration. The lesion was persistent and unresponsive to treatment. A skin biopsy was done with differential diagnosis of lupus vulgaris, tuberculoid leprosy, and granuloma annulare. Histopathology revealed features suggestive of morphea and the patient was treated accordingly. Despite treatment, the lesion continued to grow in size and a repeat biopsy was done as clinical doubt regarding the diagnosis persisted. Dermoscopy, KOH wet mount, and histopathology revealed characteristic features that clinched the diagnosis and aided in correct management of the patient with complete clearance of lesion after 4 months of therapy.