case_images: PMC10868904_01
case_images: (A) Clinical image of a 32-year-old seronegative female of necrolytic acral erythema showing bilaterally symmetrical hyperpigmented verrucous plaques present over dorsum of legs and feet. (B) Clinical image of acute lesions of the patient showing erythematous macules and plaques of irregular shape and sizes with ulcers and erosions interspersed with pustulation.
case_images: dp1401a22g001.jpg
case_images: PMC10868904_01_dp1401a22g001.jpg
case_images: f1-dp1401a22
case_images: A 32-year-old female presented with hyperpigmented plaques on the dorsum of her feet, predominantly on the medial aspect (Figure 1A). Erythematous macules, plaques of irregular shape and size varying from 0.5 cm2 to 4 cm2 in diameter were present on bilateral lower legs interspersed with follicular or non-follicular pustules, erosions and ulcers superimposed with yellowish crust (Figure 1B).
case_images: (A) Dermoscopy (polarized) showing multiple perifollicular white globules (black arrow) on intense red-violaceous background (brown arrow) interspersed with white structureless areas (green star) and short linear vessels (blue arrow). (B) Polarized dermoscopy of ulcer shows yellow globules (black arrow) with radial white striations (brown arrow) surrounded by brown dots and patches (blue arrow). (C) Dermoscopy on non-polarized mode reveals white globule (black arrow) and dirty yellow crust (brown arrow) suggestive of dried serum on red background. (D) Dermoscopic examination reveal red background (brown star) with uniform red dots (blue arrow), few red globules (green arrow) and peripheral dirty white scales (gray arrow) and brown patches (purple arrow). (E) Dermoscopy on polarized mode, red dots in uniform pattern (black arrow) can be better appreciated with whitish scales (brown arrow). (F) Dermoscopy of chronic hyperkeratotic hyperpigmented plaques presented mixture of gray brown pigmentation (black arrow) along with dirty white scales (brown arrow) and red globules (blue arrow). (G) Resolved areas reveal whitish striations in a branching pattern (black arrow) with brown patches (blue star) on dermoscopy. (H) Linear vessels (black arrow) on white background (blue star) and whitish striations (red arrow) on dermoscopic examination of these resolved areas. (I) Histopathology of the section shows mild hyperkeratosis, regular acanthosis in epidermis, numerous dilated capillaries in dermal papilla along with mild perivascular inflammatory infiltrate composed of lymphocytes and histiocytes (H&E stain; 40X). (J) Clinical image of the patient shows resolution of acute and chronic lesions at 4 months follow-up.
case_images: dp1401a22g002.jpg
case_images: PMC10868904_01_dp1401a22g002.jpg
case_images: f2-dp1401a22
case_images: Dermoscopic examination (Illuco IDS 1100, 10x magnification, polarized mode) of the acute lesions revealed multiple perifollicular white globules on intense red-violaceous background interspersed with short linear vessels (Figure 2A). Dermoscopy of the ulcer showed yellow globules with radial white striations surrounded by brown dots and patches in polarized mode and dirty yellow scales and white globules in non-polarized mode (Figure 2, B and C). D and E). Dermoscopy of chronic hyperkeratotic hyperpigmented plaques presented a mixture of gray-brown pigmentation along with dirty white scales and red globules (Figure 2F). Few resolved areas reveal whitish striations in a branching pattern with brown patches and linear red vessels on a white background (Figure 2, G and H). Skin biopsy from the hyperkeratotic plaque revealed psoriasiform dermatitis (Figure 2I). There is no relapse at 3 months follow-up (Figure 2J).