PMC4148300_01
(A) Case 1: superficial peeling scale without erythema over fingers and toes. (B) Case 2: superficial peeling scale without erythema over the palms and soles. (C) Case 3: superficial peeling scale over the palms and soles. (D) Case 4: superficial peeling scale with mild erythema over the palms and soles.
nihms618061f1.jpg
PMC4148300_04_nihms618061f1.jpg
F1
Her nephrologist replaced her tacrolimus with sirolimus 3mg daily, and within 2 weeks, she began to notice palmoplantar tenderness and peeling (Figure 1D).
PMC4148300_02
(A) Case 1: superficial peeling scale without erythema over fingers and toes. (B) Case 2: superficial peeling scale without erythema over the palms and soles. (C) Case 3: superficial peeling scale over the palms and soles. (D) Case 4: superficial peeling scale with mild erythema over the palms and soles.
nihms618061f1.jpg
PMC4148300_04_nihms618061f1.jpg
F1
Her nephrologist replaced her tacrolimus with sirolimus 3mg daily, and within 2 weeks, she began to notice palmoplantar tenderness and peeling (Figure 1D).
PMC4148300_03
(A) Case 1: superficial peeling scale without erythema over fingers and toes. (B) Case 2: superficial peeling scale without erythema over the palms and soles. (C) Case 3: superficial peeling scale over the palms and soles. (D) Case 4: superficial peeling scale with mild erythema over the palms and soles.
nihms618061f1.jpg
PMC4148300_04_nihms618061f1.jpg
F1
Her nephrologist replaced her tacrolimus with sirolimus 3mg daily, and within 2 weeks, she began to notice palmoplantar tenderness and peeling (Figure 1D).
PMC4148300_04
(A) Case 1: superficial peeling scale without erythema over fingers and toes. (B) Case 2: superficial peeling scale without erythema over the palms and soles. (C) Case 3: superficial peeling scale over the palms and soles. (D) Case 4: superficial peeling scale with mild erythema over the palms and soles.
nihms618061f1.jpg
PMC4148300_04_nihms618061f1.jpg
F1
Her nephrologist replaced her tacrolimus with sirolimus 3mg daily, and within 2 weeks, she began to notice palmoplantar tenderness and peeling (Figure 1D).
Case 4: There are modest intercellular spaces between keratinocytes in the lower epidermis, resembling spongiosis. The granular cell layer was retained, and there were layers of parakeratin alternating with thick orthokeratin on the surface of the biopsy. Clefts were apparent in the orthokeratotic layer. Inflammation was negligible, and interface dermatitis and necrotic keratinocytes were not detected.
nihms618061f2.jpg
PMC4148300_04_nihms618061f2.jpg
F2
Histologic examination via punch biopsy revealed modest intercellular spaces between keratinocytes in the lower epidermis, resembling spongiosis (Figure 2).