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Interactive Case Study - April 2026

63-year-old woman with firm, violaceous plaques in the gluteal area
Hong Yu, MD, PhD 
Mokhtar Abdelhammed, MD 
Natasha K. Klimas, MD 
 
 
A 63-year-old woman presented with a two-year history of painful, burning plaques on the buttocks, refractory to multiple prior treatments including nystatin, mupirocin, intralesional triamcinolone, a 90-day course of doxycycline, and most recently hydrocortisone 2.5% ointment. She denied itching or habitual rubbing. Of note, she reported cosmetic filler injection in the affected region more than 15 years ago. Physical examination revealed symmetric, thickened, violaceous linear plaques adjacent to the gluteal cleft. The patient reported no oral, genital, or other mucosal involvement.
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Clinical Image
Clinical Image
Figure 1: low-power
Figure 1: low-power
Figure 2: medium-power
Figure 2: medium-power
Figure 3: high-power
Figure 3: high-power
Considering the patient’s clinical history, physical examination, and the histopathologic findings provided, which of the following is the most likely diagnosis?
Allergic contact dermatitis
Cutaneous sarcoidosis
Hyaluronic acid granuloma
Lichen planus
Silicone foreign body reaction
  1. Johansen JD, Bonefeld CM, Schwensen JFB, Thyssen JP, Uter W. Novel insights into contact dermatitis. J Allergy Clin Immunol. 2022;149(4):1162-1171.

  2. Cohen E, Lheure C, Ingen-Housz-Oro S, et al. Which first-line treatment for cutaneous sarcoidosis? A retrospective study of 120 patients. Eur J Dermatol. 2023;33(6):680-685. 

  3. Mu EW, Stokar E, Franks L, Meehan SA. Histopathologic reaction patterns to differentially cross-linked hyaluronic acid fillers: a retrospective case series. J Cutan Pathol. 2021;48(6):758-762.

  4. Tekin B, Xie F, Lehman JS. Lichen planus: what is new in diagnosis and treatment? Am J Clin Dermatol. 2024;25(5):735-764. 

  5. Tausend WE, Stewart LR, Rapini RP. Morphea-like complications to illicit gluteal silicone injections. Dermatol Online J. 2015;21(4).

  6. Ryu AJ, Glazebrook KN, Samreen N, et al. Spectrum of chronic complications related to silicone leakage and migration. Am J Med. 2018;131(11):1383-1386.

  7. Nakamizo S, Kabashima K. Cutaneous granulomas: mechanisms, cellular interactions and therapeutic insights. Br J Dermatol. 2025;192(6):974-982.

 

Acknowledgements

The authors gratefully acknowledge Dr. Karishma Desai, Dr. Tim Holland, and Dr. Ronald P. Rapini of Department of Dermatology, University of Texas McGovern Medical School at Houston, for their expertise and contributions to this case.

 

Author Profiles

Hong Yu, MD, PhD

Department of Pathology and Immunology, Baylor College of Medicine

Hong Yu is a PGY-2 pathology resident at Baylor College of Medicine (BCM) with interests in dermatopathology. She completed her medical education at Southwest Medical University, earned her PhD from the University of Missouri, and has experience in next-generation sequencing. Her research focuses on Spitz melanocytomas.

 

Mokhtar Abdelhammed, MD

Department of Pathology and Immunology, Baylor College of Medicine

Mokhtar Abdelhammed is a PGY3 pathology resident at Baylor College of Medicine (BCM). He completed his medical education and molecular research scholarship at Cairo University School of Medicine and University of California San Diego (UCSD), respectively. His dermatopathology research focus on molecular characterization of melanocytic, adnexal, and soft tissue neoplasms.

 

Natasha K. Klimas, MD

Department of Dermatology, University of Texas McGovern Medical School at Houston

Dr. Natasha Klimas, MD is Board certified by the American Board of Dermatology and specializes in dermatology and dermatopathology. Dr. Klimas completed her residency at Texas Tech Health Sciences Center and a fellowship in dermatopathology at Texas Tech Health Sciences Center. Her areas of clinical interest include clinical manifestations and dermatopathology of lupus, dermatomyositis, morphea, scleroderma, sarcoidosis, vasculitis, and HIV dermatology.

 

 

 

 

 

 

 

Question:

 

 

 

 
 

63-year-old woman with firm, violaceous plaques in the gluteal area

Category

Deposition Disorders

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