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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1697 - 29 November - Dr Uma Sundram Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Case History: 10 yr old girl with linear lesion on left plantar forefoot overlying 1st metatarsal.

Case Posted by Dr Uma Sundram


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Admin_Dermpath

Posted

Uma has given us a great case here with interesting Clinical Details, enjoy.

 

Geoff Cross - DermpathPRO Projects

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vincenzo polizzi

Posted

The regular alternation of parakeratotic areas without a granular layer and slightly depressed orthokeratotic areas with prominent granular layer is subtle here and maybe inverted, but I think of an ILVEN

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urmilapandey

Posted

is there some acantholysis going on here...

 

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Dr. Mona Abdel-Halim

Posted

Epidermal verrucous nevus with epidermolytic hyperkeratosis. 

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Raul Perret

Posted

Just to throw something else for CPC. I thought the hyperkeratosis was really massive here with quite some acanthosis so I thought of a type of palmoplantar keratoderma like striated palmoplantar keratoderma (Brunauer-Fohs-Siemens syndrome) https://www.ncbi.nlm.nih.gov/pubmed/20883380 it has mutations in desmoglein-1 so could explain also the acantholytic appearance.

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Clara Jaramillo

Posted (edited)

Acatholytic epidermal nevus  >  striated palmoplantar keratoderma

 

Edited by Clara Jaramillo

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Arti Bakshi

Posted

Agree with Raul. I think this is striate palmoplantar keratoderma.  This presents as linear lesions on plams and soles. I dont think there is epidermolytic hyperkeratosis here as one should see vacuolar and granular degeneration of keratinocytes with clumping of keratin (the latter was stressed by Dr Metze in his talk on cornification disorders I attended recently). Striate palmoplantar keratoderma typically shows widening of intercellular spaces and partial dehiscence of keratinocytes, a features seen quite well in these images!

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Robledo F. Rocha

Posted

Raul hits the nail on the head classifying this case as a palmoplantar keratoderma. However, the patient has a linear lesion on plantar forefoot. Cases of striate palmoplantar keratoderma present with linear hyperkeratosis on palmar region, but rather nummular hyperkeratosis on the pressure points of the soles.

On the other hand, punctate palmoplantar keratoderma presents with the very same clinical characteristics described in this case history, including age of onset. Also, there is a marked hyperortokeratosis overlying an epidermal depression, the microscopic characteristics of punctate palmoplantar keratoderma.

Anyway, clinical correlation will reveal the correct diagnosis and possible associated features.

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Dr. Mona Abdel-Halim

Posted

I think Raul and Arti r correct.. striate PPK fits better. 

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vincenzo polizzi

Posted

Yes. I was off course with my diagnosis of ILVEN. Raul, Arti and Robledo gave me some tips about this dermpath topic. 

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Nitin Khirwadkar

Posted

Agree with striate/circumscribed palmoplantar keratoderma.

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Uma Sundram

Posted

Great ddx everyone! Clinically this was thought to be an epidermal nevus, and the findings of palmoplantar keratoderma were not present clinically. We settled on the diagnosis of acantholytic linear epidermal nevus. I think epidermolytic hyperkeratosis can be subtle, so one could also consider linear EN with EHK or ILVEN with EHK, both described in the literature (thank you Vincenzo!).

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