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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 4052 - 02 August 2022 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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"50 year old female with long standing bilateral dorsal and ventral eruption on feet with onychodystrophy.
Rule out Bazex syndrome."


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Eman El-Nabarawy

Posted (edited)

Multiple parakeratotic foci alternating with orthokeratotic foci with neutrophils and neutrophilic spongiform pustules r suggestive of palmoplantar psoriasis.. 

Edited by Eman El-Nabarawy

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Anil Patki

Posted

Multilayered parakeratosis and massive thickening of stratum corneum suggest that it could be a thick lesion of rupioid psoriasis or keratoderma blenorrhagica which occurs in reactive arthritis. Vertically alternating orthokeratosis and parakeratosis suggest intermittent activity of the disease which makes Bazex syndrome (acrokeratosis paraneoplastica) unlikely. 

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Meenakshi Batrani

Posted

22 hours ago, Anil Patki said:

Multilayered parakeratosis and massive thickening of stratum corneum suggest that it could be a thick lesion of rupioid psoriasis or keratoderma blenorrhagica which occurs in reactive arthritis. Vertically alternating orthokeratosis and parakeratosis suggest intermittent activity of the disease which makes Bazex syndrome (acrokeratosis paraneoplastica) unlikely. 

Agree with psoriasis and explanation for intermittent activity. 

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vincenzo

Posted

Agree with above. Just learnt about the vertically oriented para/ortokeratosis consistent with Bazex syndrome. Thanks Anil. 

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Eman El-Nabarawy

Posted

3 hours ago, vincenzo said:

Agree with above. Just learnt about the vertically oriented para/ortokeratosis consistent with Bazex syndrome. Thanks Anil. 

Vertically oriented para/ortho consistent with palmoplantar psoriasis and against Basex syndrome I think.. Basex syndrome characterised by necrotic keratinocytes.

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vincenzo

Posted

Ah OK! I read too quickly, sorry. Thanks for these interesting points. 

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Sisir Das

Posted (edited)

Lesion showing thick hyperkeratosis with neutrophillic collection inbetween orthokeratosis above and parakeratosis below. I believe this is the "sandwich sign" of Dermatophytosis as some structures in image3 remind me of hyphae. Also, normal granular layer if not focal areas of Hypergranulosis goes against psoriasis. Bazex typically shows interface pattern with keratinocyte necrosis, which is absent here. Based on clinical clues of lesional presence on dorsum as well as ventral aspect of foot alongwith nail dystrophy (possibly due to tinea ungium) I would like a PAS stain or KOH mount for confirmation of Tinea.

Edited by Sisir Das

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Uma Sundram

Posted

Pas is negative. We suspected palmoplantar pustulosis as patient also had lesions on her hands. Tinea cannot be entirely excluded but it is unlikely. We still included pustular psoriasis in the ddx. Agree Bazex is ruled out; spongiform pustules would be unusual in Bazex.

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