PMC3945771_01
Morphology of cutaneous lesions.. Multiple tender dusky red-colored papules and plaques over (
a) both palms, and (
b) medial aspect of both soles.
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Cutaneous biopsy findings.. Histopathology from the palmar lesion revealed hyperkeratosis, acanthosis, superficial and deep perivacular lymphohistiocytic infiltrate (highlighted by red horizontol arrow) with few neutrophils scattered in the reticular dermis, in a background of incomplete collagen degeneration and interspersed mucin (highlighted by two straight black arrows in the left lower aspect). (HE staining, 100x).
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It revealed hyperkeratosis, acanthosis, superficial as well as deep perivascular mixed infiltrate of lymphocytes, histiocytes and neutrophils in the dermis, over a background of incomplete collagen degeneration, with interspersed mucin ( Figure 2).
Treatment response.. Treatment response with 4 weeks of treatment with potent topical corticosteroid ointment - (
a) palmar lesions before treatment, (
b) palmar lesions after treatment with almost complete clearance of lesions and mild desquamation, (
c) plantar lesions before treatment, and (
d) cleared soles with only mild erythema and focal desquamation.
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This completely resolved the papules within 4 weeks (except for mild post-inflammatory desquamation) with no recurrence reported at the follow up visit one year later ( Figure 3).