PMC9166950_01
Erythroderma and thickened skin, with lichenification on some parts of the back (A). Swelling of the legs, lichenification on the knees and toes, and sunken scars on the right leg (B). Myxoid cyst, erythema, and scales were noted on the patient's fingers (C). Swelling of metacarpophalangeal joint of left thumb with psoriatic involvement on each nail (D).
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Myxoid cysts, which could spontaneously break open, were found on the arms and finger joints (Figure 1A-D).
Pathological section showing hyperkeratosis with parakeratosis and Munro micro-abscess (arrow) formation in the epidermis (Hematoxylin and Eosin, x400) (A). Alcian blue stain showing excessive mucin deposition in the dermis (Alcian blue, x200) (B).
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Acanthosis, irregular elongation of rete ridges, and dilation of papillary blood vessels could be seen (Figure 2A). Alcian blue stain showed mucus cells and excessive mucin deposition in the dermis (Figure 2B).
Complete resolution of the lesions leaving hyperpigmented spots throughout the body after 6 months (A). Complete regression of skin, nail lesions, and the swelling joint (B).
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However, to our surprise, at a 6-month follow-up, he returned with complete resolution of the lesions and swelling of joints and extremities, leaving hyperpigmented spots throughout the body (Figure 3A and B).
Pathological section showing pigmentation on the basal layer (arrow), and pigmentophages found in the dermis. No mucin deposition was noted (H&E, x200).
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Another skin biopsy was then taken from the right arm's pigmented lesion, which showed no mucin deposition in the dermis (Figure 4).