Hyperkeratotic plaques on the lower extremities

Presenter: Heather Orkwis, DO
Dermatology Program: St. Joseph Mercy Hospital
Program Director: Daniel Stewart, DO
Submitted on: Dec 17, 2011

CHIEF COMPLAINT:  A 44-year-old woman presented with a greater-than-10-year history of dark, itchy spots on legs.

CLINICAL HISTORY:

Signs and symptoms:  She complained of pruritic, progressively worsening dark spots on the bilateral anterior lower legs.

Previous Treatment:  She used a bleaching cream on the areas 8 years prior without improvement.

Other information:  The patient has insulin resistance, hypertension and arthritis.

PHYSICAL EXAM:

There are hyperpigmented, keratotic plaques on the bilateral anterior lower extremities.

 

LABORATORY TESTS:

None

DERMATOHISTOPATHOLOGY:

Punch biopsy showed a hyperkeratotic epidermis overlying papillary dermal deposits of homogenous material.

 

DIFFERENTIAL DIAGNOSIS:

1.   Acquired Ichthyosis
2.   Lichen Aureus
3.   Lichen Simplex Chronicus
4.   Keratosis Pilaris
5.   Scleroderma


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