PMC5688342_01
(a) Linearly arranged hyperkeratotic and scaly gray papules on the right fifth finger and dorsum of the hand extending to the right elbow. (b) Multiple hyperkeratotic papules present within a tattoo on the posterior right arm.
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Physical examination revealed hyperkeratotic and scaly gray papules coalescing into a linear plaque of the right dorsal fifth finger extending medially to the right elbow (Figure 1(a)). Of note, scaly papules were also present on a tattoo above the right elbow (Figure 1(b)).
(a) Histopathological slides. At 2x magnification there is parakeratosis and epidermal acanthosis. (b) Histopathological slides. At 10x magnification a regularly acanthotic epidermis with hyperkeratosis alternating with parakeratosis. Rete ridges show psoriasiform hyperplasia.
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Histological examination of the specimen revealed parakeratosis with uniformly acanthotic epidermis (Figure 2).
(a) Close-up of lesions present on right fifth finger and dorsum of hand. At two-week follow-up, new papules appear in the area that is previously electrodessicated (black arrow). (b) Remarkable clearing of the lesions and postinflammatory hypopigmentary changes can be seen after 8 doses of ixekizumab. (c) Psoriatic lesions are no longer present on the tattoo after treatment with 8 doses of ixekizumab.
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At a follow-up visit 2 weeks later, the patient developed new papules with similar morphology in the area that was previously electrodessicated (Figure 3(a)). Four months later and after 8 doses of ixekizumab, we observed almost-complete resolution of the cutaneous lesions (Figures 3(b) and 3(c)).