Acta Dermato-Venereologica 99-10CompleteContent | Page 35

939 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