Case Number : Case 2617 - 17 July 2020 Posted By: Dr. Richard Carr

If this is the only lesion then I would call it a warty dyskeratoma.

Porokeratosis ptychotropica

I know only an entity able to simulate so many disease simultaneously: Grover’s disease. It can be pemphigus like and porokeratosis like and here psoriasis like and Darier like also. But clinically doesn’t fit well. I don’t know. 

?Pityriasis rubra pilaris with acanthlolytic dyskeratoses

On 18/07/2020 at 20:44, vincenzo said:

I know only an entity able to simulate so many disease simultaneously: Grover’s disease. It can be pemphigus like and porokeratosis like and here psoriasis like and Darier like also. But clinically doesn’t fit well. I don’t know. 

I agree. Grover's disease can have mix patterns including porokeratosis like, pemphigus like and dyskeratosis. 

A solitary "plaque" doesn't sound like Grover's disease clinically.  The lesions are generally quite small and numerous.

warty dyskeratoma, clinical description does not fit in with Grover's disease and Porokeratosis ptychotropica will be in the gluteal region

I suppose  a solitary lesion of pemphigus should be excluded by immunofluorescence.  it depends on how long the lesion had been present.

Well I cheated a little and ommited the known previous diagnosis of Darier's (when much younger with a positive family history) and this was a case in which the clinical colleagues were querying psoriasis!

So it's dual pathology: Psoriasis in a patient with Darier's. I think maybe Sherlock Holmes would have considered this to be honest as there are typical features of psoriasis in some areas (regular elongation of the rete, absent graular layer, layered and rather confluent parakeratosis with intra-corneal Munro microabscesses, intra-epidermal spongotic microabsecess of Kagoj and dilated capillary loops). In other areas we have multifocal acantholytic dyskeratosis with corps ronds and given the previous diagnosis (with positive family history) I thought this was compatible with backgound Darier's.

Examiner's love dual pathology although it would be a bit cruel to omit the history completely!

Yes, if you ignore the acantholysis and dyskeratosis the psoriasis  is there looking at you!

interesting sir, Psoriasis was staring at us but we fell for something

On 20/07/2020 at 11:14, Dr. Richard Carr said:

Well I cheated a little and ommited the known previous diagnosis of Darier's (when much younger with a positive family history) and this was a case in which the clinical colleagues were querying psoriasis!

So it's dual pathology: Psoriasis in a patient with Darier's. I think maybe Sherlock Holmes would have considered this to be honest as there are typical features of psoriasis in some areas (regular elongation of the rete, absent graular layer, layered and rather confluent parakeratosis with intra-corneal Munro microabscesses, intra-epidermal spongotic microabsecess of Kagoj and dilated capillary loops). In other areas we have multifocal acantholytic dyskeratosis with corps ronds and given the previous diagnosis (with positive family history) I thought this was compatible with backgound Darier's.

Examiner's love dual pathology although it would be a bit cruel to omit the history completely!

Nice!

I'm revisiting some old cases and had totally forgotten this one. I thought psoriasis & grover's (porokeratosis-like) seeing it blind!