Acta Dermato-Venereologica 99-9CompleteContent | Page 28

841 Progressive Erythroderma without Malignancy in the Skin: A Quiz Hiroyuki IRIE, Teruki DAINICHI*, Yo KAKU and Kenji KABASHIMA Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto 606-8507, Japan. E-mail: [email protected] A 60-year-old woman with no medical history or cur­ rent medications presented with scaly red papules on her extremities. The patient had visited several dermatology clinics and had been treated with topical corticosteroids, phototherapy, and oral retinoids. None of these treatments had resolved the skin eruptions. She developed generalized erythroderma 8 months after onset of the condition and was referred to our hospital for further evaluation and treatment. The patient exhibited confluent erythema affecting the face, trunk, and extremities with severe pruritus (Fig. 1a, b). She had hyperkeratosis on the lower extremities, especially on the soles of the feet (Fig. 1b, c). She did not report any other somatic symptoms. Laboratory analysis showed mild elevation in serum levels of liver enzymes and hypogam­ maglobulinaemia. Histological findings of the skin biopsy specimen revealed parakeratosis, marked papillomatous acanthosis, necrotic keratinocytes in the epidermis, and interface vacuolar changes with lymphocytic infiltration in the superficial dermis (Fig. 1d, e). What is your diagnosis? See next page for answer. QUIZ SECTION Fig. 1. (a, b) Confluent elevated erythema with scaling on the back and lower legs. Hyperkeratosis scattered on the lower legs. (c) More severe hyperkeratosis on the soles. (d) Haematoxylin and eosin staining revealed parakeratosis and papillomatous acanthosis. (e) A number of necrotic keratinocytes were present in the epidermis, vacuolar changes and lymphocytic infiltration in the superficial dermis. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3206 Acta Derm Venereol 2019; 99: 841–843