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Distinct Hyperkeratotic Lesions on Acral Skin and Lips: A Quiz
Youming MEI 1# , Zhiming CHEN 1# , Wei ZHANG 1,2 , Jingshu XIONG 1 and Hongsheng WANG 1,2
1
Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, 210042, and 2 Jiangsu Key
Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China. E-mail: [email protected]
#
These authors contributed equally to this work.
A 50-year-old man presented with hyperkeratotic scales
on his lips, asymptomatic, round, discrete, hyperkeratotic,
verrucous nodules on the dorsa of the interphalangeal and
metacarpophalangeal joints, the left ear, right heel (Fig.
1A–E), and poikiloderma over his fingers and left ear (Fig.
1B). The lesions had gradually increased over a period of
20 years. Laboratory examinations revealed reduced pla-
telet number (92×10 9 /l), positive antinuclear antibodies
(1:160, speckled pattern), anti-dsDNA and anti-SSA/Ro.
Histopathology of biopsied foot lesions revealed marked
hyperkeratosis, acanthosis and hypergranulosis (Fig. 1F).
There was lymphocyte infiltration around the vessels and
in the upper dermis, and mucin deposition in the superficial
and mid-dermis (Fig. 1G). Direct immunofluorescence of
IgG and complement 3 was negative. After treatment with
methylprednisolone, 8 mg q.d., hydroxychloroquine 100
mg and viaminate 50 mg b.i.d., topical 0.05% halometasone
cream b.i.d. for 1 month, the patient reported that most of
the lesions became flatter.
What is your diagnosis? See next page for answer.
QUIZ SECTION
Fig. 1. (A, B, E) Verrucous hyperplastic plaques
and nodules on the interphalangeal and
metacarpophalangeal joints, and right heel. (C,
D) Hyperplastic plaques on the lips, nodule and
the poikiloderma (arrow) on the left ear. (F, G)
Histopathological aspects of the right heel lesion,
demonstrating lymphocyte infiltration (arrowhead)
and mucin deposition in the dermis (arrow), original
magnification: (F) ×50, (G) ×200.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-2879
Acta Derm Venereol 2018; 98: 475–476