Case Number : Case 4124 - 10 Nov 2022 Posted By: Saleem Taibjee

'Dirty - warty' papules histologically showing acantholytic dyskeratosis diagnostic of Darier disease. Exacerbation could be due to summer. 

Darier?, I think i see grains. Did she had v shaped nailtips?

Thanks Saleem for sharing clinical photographs and superb-quality photomicrographs.

It is Darier’s, the photos shows rather large numbers of erosions (some monomorphic) especially on back. In context of an acute widespread flare up, one has to consider super-added infective causes (bacterial/viral (HSV). 

Iam not sure there is a possible multi-nucleate keratinocyte above the acantholysis in the penultimate photo or early viral related cytopathic changes in the last photo or me imagining/hallucinating it! will wait for your constructive comments to enlighten us in due course. 

On 16/11/2022 at 09:03, Saman Fatah said:

Thanks Saleem for sharing clinical photographs and superb-quality photomicrographs.

It is Darier’s, the photos shows rather large numbers of erosions (some monomorphic) especially on back. In context of an acute widespread flare up, one has to consider super-added infective causes (bacterial/viral (HSV). 

Iam not sure there is a possible multi-nucleate keratinocyte above the acantholysis in the penultimate photo or early viral related cytopathic changes in the last photo or me imagining/hallucinating it! will wait for your constructive comments to enlighten us in due course. 

 

Agree..

Agree. Darier’s disease. 

Apologies for the late 'answer' on this one.

Yes, this is a recent case of Darier disease with typical acantholytic dyskeratosis. I wanted to include it because of the nice clinical and histological comparison. As alluded to above, it is worth considering added infection (bacterial or herpes) in patients flaring with this condition, although in this particular instance I think it was just an unexplained flare of the disease itself.

BW

Saleem