Presenter: Sarah Hocker, D.O. and Lauren Dozier, D.O.
Dermatology Program: Larkin Community Hospital, South Miami, FL
Program Director: Stanley Skopit, DO, MSE, FAOCD, FAAD
Submitted on: Oct 5, 2017
CHIEF COMPLAINT: A 12-year-old male with a history of blindness in his left eye, presented to our clinic for evaluation of an itchy, scaly rash on his body, face, and scalp.
CLINICAL HISTORY:
Signs and symptoms: The patient states that the rash had been present for 5 years now, and is worsening. He admits to itching but denies pain. The patient reports previously seeing a dermatologist a few years ago that performed two punch biopsies that came back as severe plaque psoriasis. He denies a family history of a similar rash.
Previous Treatment: He tried lactic acid creams, urea cream, numerous topical and intralesional corticosteroids and pimecrolimus.
Other information:
PHYSICAL EXAM:
Generalized verrucous plaques with thick spiny scales on the scalp, face, and back. Fingernail pitting present.
LABORATORY TESTS:
DERMATOHISTOPATHOLOGY:
Hyperkeratosis, parakeratosis, and papillomatosis with acanthosis.
DIFFERENTIAL DIAGNOSIS:
1. Ichthyosis Hystrix
2. Psoriasis
3. Epidermolytic Ichthyosis
4. Erythrokeratodermia variabilis
5. Epidermolytic palmoplantar keratoderma