We report a rare case of acitretin-induced palmar plantar haemorrhagic lesions in a patient being treated for Darier disease. The pathogenesis for this type of clinical presentation is unknown, but it is thought that a combination of local mechanical trauma, long-term effects of treatment with acitretin and abnormal keratinocytes in Darier disease in our patient may have resulted in the formation of haemorrhagic blisters. 3,4

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A 53-year-old woman presented with an isolated and nontender necrotic nodule on her left eyelid, which had begun as a small rapid-growing inflammatory papule 3 weeks earlier.Physical examination revealed a 15 mm, erythematous, firm but mobile nodule with a crusted and necrotic core (Fig. 1A). No other cutaneous or mucosal lesions were identified. There was neither regional lymphadenopathy nor systemic involvement and ophthalmological findings were otherwise unremarkable. All laboratory and microbiological studies showed normal or negative results.The patient had a previous 6-month history of disseminated and self-healing crops of similar cutaneous lesions affecting her upper trunk and extremities, which were biopsied months ago (Fig. 1B, C).The eyelid nodule resolved itself spontaneously within 2 weeks. There was no recurrence during the following year. Fig. 1. (A) Isolated erythematous and crusted nodule on the upper left eyelid. (B) The microscopic examination of an incisional skin biopsy found the presence of a diffuse wedge-shaped dermal infiltrate (H&E stain, × 40), (C) containing large atypical lymphocytes within a dense inflammatory background of smaller lymphocytes, histiocytes, neutrophils, and abundant eosinophils (H&E stain, × 200).

LetterAngiomatosis dérmica difusa de la mama: aportación de un nuevo caso en paciente no fumadora

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