PMC7529171_01
Extensor predominance of hyperkeratotic dull erythematous grouped papules noted over the a) extensor forearm, b) cubital fossa, c) buttocks d) back
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F1
Cutaneous examination revealed inflammatory papules and few nodules on the face on a background of closed and open comedones [Figure 1a]. Many dull erythematous to hyperpigmented scaly plaques were noted over the extremities, trunk, and buttocks, with extensor predominance [Figure 1b-d]. Follicular hyperkeratotic papules were seen on the shins giving a "nutmeg grater" feel [Figure 1b].
(a and b) Palmo-plantar keratoderma and c) nail dystrophy
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F2
Yellow waxy palmoplantar keratoderma was present [Figure 2a and b]. All her nails were dystrophic, with nail plate thickening and subungual hyperkeratosis but no pits [Figure 2c].
Haematoxylin and eosin stain; original magnification 10x, alternating hyperkeratosis and parakeratosis
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F3
The upper and mid-dermis showed a mild perivascular lymphocytic infiltrate [Figure 3a and b].