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SkIndia Quiz 55: Chronic hyperkeratotic acral plaques

 Department of Dermatology, AIIMS, Rishikesh, Uttarakhand, India

Correspondence Address:
Shilpi Sharma,
Department of Dermatology, AIIMS, Rishikesh, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_366_17

How to cite this URL:
Sharma S, Sharma A, Hazarika N. SkIndia Quiz 55: Chronic hyperkeratotic acral plaques. Indian Dermatol Online J [Epub ahead of print] [cited 2019 Nov 22]. Available from: http://www.idoj.in/preprintarticle.asp?id=270233

   Clinical and Histopathologic Findings Top

A 37-year-old male presented with a history of gradually progressive darkening of dorsa of hands and feet with overlying hyperpigmented plaques since 5 months. It was associated with mild pruritus, and there were no systemic symptoms. On examination, there were well-defined hyperpigmented plaques distributed symmetrically over dorsa of hands and feet with overlying thick adherent scales. A diffuse hyperpigmentation of the surrounding skin was noted extending till lower third of both legs and the metacarpophalangeal joint (MCP) joints of upper limbs [Figure 1]a. No changes were observed in hair, nail, and oral mucosa. Complete Hemogram, urine routine, liver function test, and renal function test were within normal limits. Serology for Hepatitis B, HIV, and ELISA were negative, but Hepatitis C serology was reactive with hepatitis C virus (HCV) Genotype 3 and viral load of 3,050,000 IU/mL. Skin biopsy obtained from one of the plaques revealed hyperkeratotic epidermis with acanthosis, psoriasiform hyperplasia, and hypergranulosis. Dermis had peri-vascular and peri-appendageal inflammatory infiltrate comprising of lymphocytes, macrophages, and melanin incontinence [Figure 2]a and [Figure 2]b. The patient was started treatment. A near complete resolution of lesions was seen at the end of 1.5 months of the treatment [Figure 1]b.
Figure 1: (a) Hyperkeratotic acral plaques on dorsum of hands and feet of a patient before therapy. (b) Lesions after 6 weeks of therapy in same patient

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Figure 2: (a) Photomicrograph showing hyperkeratosis and parakeratosis (H and E, ×10). (b) Photomicrograph showing prominent stratum granulosum, acanthosis, and mild upper dermal infiltrate (H and E, ×40)

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   Question Top

What is your diagnosis?


  [Figure 1], [Figure 2]


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