Acta Dermato-Venereologica 99-10CompleteContent | Page 35
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Linear Hyperkeratotic Papules on Extremities Together with Oral Ulcers: A Quiz
Stefanie HEYNE, Bodo HÄGELE, Stefan BEISSERT and Claudia GÜNTHER
Department of Dermatology, University Hospital Dresden, DE-01307 Dresden, Germany. E-mail: [email protected]
A 63-year-old woman presented with a 6-year history of
a cutaneous eruption in a distinctive linear and reticular
pattern. Hyperkeratotic dark erythematous papules with
fine white scaling were spread mainly on the interior sides
of her arms (Fig. 1A) and legs (Fig. 1B). Erythema and
scaling was present on the perioral region (Fig. 1C). In
addition, she had painful oral ulcers on the mucosal lips,
buccal mucosa and tongue (Fig. 1D). Periungual erythema
and swelling was present on the fingers (Fig. 1E). She had
tender, erythematous subcutaneous nodules on the lower
legs (Fig. 1F).
Skin biopsy from the linear hyperkeratotic plaques de-
monstrated a partially acanthotic and atrophic epidermis
with parakeratosis, dyskeratosis and an underlying lichenoid
interface dermatitis. The dermal infiltrate mainly contained
lymphocytes and histiocytes (Fig. 2)
The patient had a history of signs reminiscent of sarcoi-
dosis in the lung. Bilateral hilar shadowing was detected
on X-ray 5 years previously. Treatment with methotrexate
for 2 years led to complete regression of pulmonary infil-
tration. The cutaneous symptoms were not significantly
ameliorated.
What is your diagnosis? See next page for answer.
Fig. 1. Erythematous papules with fine white scaling on: (A) arms and (B) legs. (C) Perioral
erythema, (D) oral ulcers, (E) periungual erythema and swelling, and (F) erythematous
subcutaneous nodules on the lower legs.
QUIZ SECTION
Fig. 2. Histology of skin biopsy: acanthotic and atrophic
epidermis with parakeratosis (), dyskeratosis ()
and an underlying lichenoid interface dermatitis (),
dermal infiltrate ( ) mainly contained lymphocytes
and histiocytes (HE staining ×100).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3239
Acta Derm Venereol 2019; 99: 939–940