Sudden onset of acral erythema with hyperkeratosis and pityriasiform scales on soles, fingertips, nose and ear helices

Abstract

A 61-year-old man presented with a one-year history of skin changes in acral regions and nail changes affecting both hands. His overall health and nutritional status were otherwise good. In the past year, his symptoms had worsened despite treatment with isosorbide dinitrate ointment and mometasone cream. There was an incidental fi nding of chronic nicotine abuse (40 pack years) as well as grade II hemorrhoids. The patient had no fever, night sweats, weight loss, fatigue, pain, or loss of appetite. There were no dermatological disorders in the patient's own or family history. Clinical appearancesThe results of the clinical examination revealed acral erythema with pityriasis-like scaling on the fi ngertips, the tip of the nose, and the helices. Nail changes were identifi ed on both hands and feet, consisting of onychodystrophy, subungual hyperkeratosis, and onycholysis (Figure 1, 2). Palpation of the lymph nodes did not reveal any abnormalities. The remainder of the skin as well as the visible mucous membranes also appeared normal. Histological analysisThe epithelium was hyperkeratotic with normal stratifi cation and parakeratosis. Subepidermal appearances included

Palmoplantare Keratosen (PPK): erworbene und genetische Ursachen eines gar nicht so seltenen Krankheitsbildes

“…Da in diesen Fällen eine PPK das erste sichtbare Symptom darstellt, kann das Wissen des Arztes um diesen Zusammenhang für den Patienten entscheidend sein. Beispiele für paraneoplastische Palmoplantarkeratosen sind das Sézary‐, das Bazex‐ und das genetisch bedingte Howel‐Evans‐Syndrom . Im Falle des Bazex‐ und des Sézary‐Syndroms führt eine Behandlung der zugrundeliegenden malignen Erkrankung zur Verbesserung der kutanen Symptome.…”

Is it just a psoriasiform dermatitis?

“…Squamous cell carcinomas of the head and neck and squamous cell tumors of unknown primary with cervical lymph node metastases were the most commonly associated neoplasms, suggesting that the factor(s. Therefore, BS is an important marker for internal malignancy. Squamous cell carcinoma of the aerodigestive tract or metastatic cancer to the lymph nodes of the neck are the most commonly associated malignancies [5]. Other neoplasms have been reported include adenocarcinomas of the bladder, colon, prostate gland, lung, and breast and also Hodgkin disease [6][7][8][9].…”

Acitretin amelioration of Acrokeratosis Paraneoplastica (Bazex Syndrome) in cases of incurable squamous cell carcinoma of the hypopharynx

“…Bazex syndrome is a rare paraneoplastic syndrome and dermatosis that usually affects white men age 40 or older [1,2]. It is found as a paraneoplastic syndrome in squamous cell carcinomas of the upper respiratory or digestive tract, but has been reported in other malignancies as well, including breast, lung, prostate gland, esophagus, stomach, colon, and bladder [1,2,3]. No cases have been reported without an underlying malignancy [4].…”

“…Generally, histopathologic findings are nonspecific, but include spongiosis and interface change in the epidermis and hyperkeratotic epithelium with focal areas of parakeratosis, acanthosis, dermal perivascular infiltrate, and diffuse lymphocytic infiltrate in the upper dermis [1,2].…”