A 50-year-old man presented with a 10-year history of intense pruritic skin eruptions on both legs. Physical examination revealed multiple, discrete, hyperkeratotic papules coalescing to form large gray-brown plaques on the surface of the right pretibial area and the medial aspect of the left lower leg. Results of histopathology revealed eosinophilic, globular deposits expanding the dermal papillae with a sparse, superficial perivascular lymphocytic infiltrate and melanophages. Congo red stain under polarizing light gave these depositions apple-green birefringence. His medical history was unremarkable. None of his family members had a similar skin condition.
The most likely diagnosis is
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Hypertrophic lichen planus
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Prurigo nodularis
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Lichen simplex chronicus
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Pretibial myxedema
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Lichen amyloidosis
Answer on page 1234
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