Case Number : Case 2111 - 10 July 2018 Posted By: Dr. Hafeez Diwan

Is that a cornoid lamella? Porokeratosis?  I’m still pondering....

Hypergranulosis, eosinophilic keratinocytes with retained nuclei, basket weave orthokeratosis and a dermal perivascular lymphocytic infiltrate. These findings suggest hypergranulotic dyscornification. Other possibilities are unusual form of Darier's disease ( mother and daughters affected, dyskeratotic cells in epidermis) and Grover's with epidermal dysmaturation pattern.

(Acantholytic) dyskeratosis with a family history - Darier disease. Deepers may show more acantholysis.

Disseminated superficial actinic porokeratosis could be a reasonable spot. Clinically DSAP fits well. And where I see parakeratosis I don't see granular layer(or hypogranulosis). So what we are seeing, according with Alice, could be a cornoid lamella.

Porokeratosis had crossed my mind too but there are three cornoid lamella- like structures in one section in fig 1 which I think is unusual for porokeratosis.

Given the history, I ended up calling this Darier's.

Papulosquamous does fit better with Darier’s. Interesting case!