PMC5869485_01
a Erythematous, scaly plaques involving both legs. b Psoriatic lesions over both elbows.
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F1
On examination, scaly erythematous plaques were found exclusively on the left side of the lower limbs, in lines running on the left leg from the anterior aspect to the dorsum of the foot, with silvery, scaly plaque and papule over the right leg, and with multiple psoriatic plaques over both elbows (Fig. 1a, b).
a Hematoxylin and eosin, x10. Skin punch biopsy from right leg showing psoriasiform hyperplasia with subtle papillomatosis and hyperparakeratosis. b Hematoxylin and eosin, x40. Skin punch biopsy from the right leg exhibits almost confluent parakeratosis and an absent granular layer with Munro's microabscesses. Some dilated papillary dermal vessels are noted. c Hematoxylin and eosin, x20. Skin punch biopsy from left leg showing psoriasiform hyperplasia with subtle papillomatosis and hyperparakeratosis. Absent granular layer is evident, with denuded foci. Also seen is a hair follicle with parakeratotic plugging. d Hematoxylin and eosin, x40. Skin punch biopsy from left leg exhibiting almost confluent parakeratosis and an absent granular layer with Munro's microabscesses.
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F2
In the dermis, mild, superficial perivascular lymphohistiocytic infiltrate was appreciated (Fig. 2a, b, c, d).
a Improvement of both legs after 52 weeks of treatment with etanercept. b Improvement of both elbows after 52 weeks of treatment with etanercept.
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F3
The plaques on the legs and elbow had either disappeared completely or thinned and faded (Fig. 3a, b) after 52 weeks of treatment.