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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 2573 - 18 May 2020 Posted By: Dr. Mona Abdel-Halim

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M-40, Sharply demarcated scaly erythematous plaques over both palms and palmar aspects of the fingers. Fewer lesions on the soles.
Biopsy from the palm.


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Meenakshi Batrani

Posted (edited)

Acral/palmoplantar psoriasis

Edited by Meenakshi Batrani

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vincenzo

Posted

Have a question: is dermal infiltrate neutrophilic?  Thinking about a pustulosis palmoplantar with overlying lichen simplex chronicus. 

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Anil Patki

Posted

On the palms, it is futile to try to differentiate between psoriasis and chronic lichenified dermatitis. The patterned parakeratosis may suggest intermittent activity of dermatitis and spongiosis with the infiltrate support it. It could also be pityriasis rubra pilaris which has palmoplantar keratoderma as one of the features. Clinical correlation as regards any other lesions on the body is needed. 

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Krishnakumar subramanian

Posted

psoriasiform dermatitis 

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John Zhang

Posted

Anil raised a good point! To me the histology favor spongiotic dermatitis (dyshidrotic dermatitis) with superimposed features of lichen simplex chronicus. There are a few neutrophils in the stratum corneum, but mixed with a small amount of fibrin. To me the later is more compatible with spongiotic dermatitis than psoriasis. But I wasn't sure because of the clinical description of a "sharply demarcated" plaque, which I wonder would hint for psoriasis. Today I was going over some older cases in spot diagnosis, and encountered a similar case posted by Dr. Carr. Now I am comfortable to favor spongiotic dermatitis!

 

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Dr. Mona Abdel-Halim

Posted

Interesting discussion! This case reflects the great difficulty in differentiating between psoriasis and eczema on palms and soles as they share some features. Clinical correlation is mandatory. The presence of multiple parakeratotic foci placed vertically and alternating with orthokeratosis favored the diagnosis of psoriasis, together with the presence of neutrophils and or serum in the parakeratotic layers (Aydin et al, 2008). These features were very evident in this case. Also spongiosis which can be seen in palmoplantar psoriasis is mainly seen in the lower epidermis in psoriasis as in this case. The clinical correlation with sharply demarcated plaques also favored psoriasis. 

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