Although the clinical presentation of the patient, neutrophilic infiltration and RBC leakage may go with those of Dermatitis Herpetiformis and Vasculitis respectively, the histopathologic findings of the case rules out both Dermatitis Herpetiformis & standard Vasculitis!.

The most critical and unique features in the biopsy are:

1. ​Foci of dermal collagen degeneration (Necrobiosis).
2. ​Palisading granulomas surrounding the degenerating collagen.

And the most likely diagnosis based on the full clinical and pathological picture is: Necrobiosis Lipoidica (NL).

—Cyclic mood symptoms before menses

—Resolve with menstruation

—Emotional, not physical predominance

Cystic Fibrosis

Perfect

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