PMC3505938_01
(a) Salmon-colored erythematous plaques with superficial thin scales involving the left temple site where imiquimod 3.75% was applied and extending over forehead, scalp, and ear. (b) Small, perifollicular, salmon-colored papules coalesce to form a background of erythema, with islands of sparing over chest. There are overlaying, prominent, erythematous oval plaques with flaky scale.
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fig1
On examination, he had salmon-colored erythematous plaques with superficial thin scales covering his face, scalp, and neck (Figure 1(a)). Similar lesions were noted on his trunk and extremities, some coalescing to form large areas of erythema (Figure 1(b)).
Skin biopsy, left abdomen. Alternating parakeratosis and orthokeratosis in the stratum corneum in vertical and horizontal sections. A focus of acantholysis in the epidermis with suprabasilar and subcorneal location. Within the superficial dermis, there is a sparse superficial perivascular and interstitial lymphocytic infiltrate. Hematoxylin-eosin stain (a) x4 and (b) x20 magnification.
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fig2
Histopathologic sections revealed alternating parakeratosis and orthokeratosis in both the vertical and horizontal directions and a mildly acanthotic epidermis with confluent hypergranulosis (Figure 2(a)). The epidermis had multiple small foci of acantholysis, located at suprabasilar or subcorneal levels (Figure 2(b)).