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

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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35 year-old female with papulosquamous rash, with daughters who have similar rash. This biopsy is from an unspecified site.


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Alice Roberts

Posted

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

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Anil Patki

Posted

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.

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John Zhang

Posted

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

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vincenzo

Posted (edited)

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.

Edited by vincenzo

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Anil Patki

Posted

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.

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Dr. Hafeez Diwan

Posted

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

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Alice Roberts

Posted

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

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