Case Number : Case 1992 - 24 Jan 2018 Posted By: Iskander H. Chaudhry

I found this art to describe this intricate case:

https://www.ncbi.nlm.nih.gov/m/pubmed/19508573 and this other 

https://www.ncbi.nlm.nih.gov/m/pubmed/25800103/?i=5&from=/19508573/related

thinking of a drug induced disseminated actinic-like porokeratosis. 

I liked the first citation in particular!

The main feature on clinical photos which is difficult to magnify is light brown macules but one can not comment if any of these has a raised ridges edges (which needs to be carefully searched for).

The histology shows features of "developing" cornoid lamella with pigment incontinence. in papillary dermis

This looks like a rare variant of porokeratosis EPPK (Eruptive Pruritic Papular Porokeratosis )where the inflammatory phase improved to a certain degree leaving residual lesions and post inflammatory changes.

Meant to be EPPP rather than EPPK

Fits with eruptive pruritic papular porokeratosis as Dr Fatah said 

I like EPPP as well.

Please Dr Iskander, what's the diagnosis of case n. 1987?

Looks like EPPP. Were the lesions pruritic? Some of these have been reported in patients with internal malignancies.

Hi,

Dr Chaudhry has added the MelanA for this case. He will add the diagnosis within the next day.

The word ' persistent' needs to be added to the terminology to describe this case

Dear All 

Dr Chaudhry checked with the clinician and the rash is not pruritic 

Dr Chaudhry's comments

'In some of the literature eruptive disseminated porokeratosis (EDP) is an umbrella term which encompasses eruptive pruritic papular porokeratosis (EPPP). Given the lack of pruritus and lack of papules in this case we felt EDP is preferable to EPPP. As stated by NItin EDP has an association with malignancy (hepatocellular carcinoma, cholangiocarcinoma), but others include ovarian carcinoma and lymphoma. so one should scan patients with this diagnosis. 

So many thanks again for your expert insights into this case.

Iskander '