PMC3699945_01
A, B, C, D. Multiple excoriated hyperkeratotic papules and nodules with central crust involving the whole integument
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Pruritus had started 10 months before and subsequently there was onset of keratotic papules and nodules (Figure 1).
A. Acanthosis of the epidermis with hypergranulosis and ortho-parakeratosis. On the left side, cup-shaped depression of the epidermis with parakeratotic material and debris. In the dermis fibrosis, teleangiectatis vessels and aspecific lymphohistiocytic infiltrate. B. Cup-shaped depression of the epidermis which is filled by parakeratotic keratin and neutrophils. At the bottom basophilic collagen fibres in vertical orientation that are extruded
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Histopathology showed irregular epidermal hyperplasia with hypergranulosis, orthokeratosis and a cup-shaped depression of the epidermis with parakeratotic material, debris and extruded basophilic collagen fibres at the bottom (Figure 2).
A, B, C, D. Multiple postinflammatory hyperpigmentations involving the whole integument after 8 months of treatment
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Clinical response was maintained at 14-month follow-up visit with uninterrupted well-tolerated allopurinol therapy (Figure 3).