Presenter: Portela D., Laffer M

Dermatology Program: Oakwood Hospital – Southshore

Program Director: Steve Grekin DO

Submitted on: May 4, 2015

CHIEFCOMPLAINT: Erythematous papules and patches progressing from head to chest and upper arms after sunburn

CLINICAL HISTORY: A 50-year-old Caucasian male presented with a three-day history of mildly pruritic erythematous papules and patches progressing from his head to his chest and upper arms after experiencing a sunburn during work. The patient complained of a pruritic erythematous rash from his scalp to the mid trunk. Additionally, there was erythema and hyperkeratosis of his hands and feet. The patient’s primary care provider had been treating the patch with a mid potency topical corticosteroid. The patient had a family history significant for psoriasis. He has a past medical history significant for hypertension, treated with atenolol. A review of systems was negative for constitutional symptoms.

PHYSICAL EXAM:
Physical examination revealed a well-appearing male with brightly erythematous, hyperkeratotic, follicular papules and scaly patches coalescing on the scalp, face, chest, and upper extremities. Examination of his hands and feet revealed erythema and hyperkeratosis of the palms and soles.

LABORATORY TESTS:

Initial laboratory evaluation was within normal limits and included complete blood count with differential, comprehensive metabolic panel, and urinalysis.

DERMATOHISTOPATHOLOGY:

Two 4mm punch biopsies were obtained and revealed elongation of rete ridges, hyperkeratosis, and confluent parakeratosis. There was a mild superficial perivascular lymphocytic and neutrophilic infiltrate as well as the presence of extravasated red blood cells. PAS stain was negative for fungi and the colloidal iron stain was negative for mucinosis.

DIFFERENTIAL DIAGNOSIS:

1.   Pityriasis Rubra Pilaris
2.   Psoriasis
3.   Cutaneous T-Cell Lymphoma
4.   Dermatomyositis