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Disseminated dermatosis in seborrheic areas in a 10-year-old boy
Disseminated dermatosis in seborrheic areas in a 10-year-old boy Sandra Cecilia Garcia-Garcia, MD, Esperanza Welsh, MD, Jorge Ocampo-Garza, MD, Jorge Ocampo-Candiani, MD, and Oliverio Welsh, MD, DrSc Nuevo Le on, Mexico
From the Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Universidad Aut onoma de Nuevo Le on, Monterrey. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Oliverio Welsh, MD, DrSc, Hospital Universitario ‘‘Dr Jos e Eleuterio Gonzalez,’’ Universidad Aut onoma de Nuevo Le on, Av Francisco I. Madero Pte s/n y Av Gonzalitos s/n,
Col Mitras Centro, Monterrey, Nuevo Le on, Mexico 64460. E-mail: [email protected]. J Am Acad Dermatol 2016;75:e89-90. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.12.012
e89
e90 Garcia-Garcia et al
J AM ACAD DERMATOL
SEPTEMBER 2016
A 10-year-old boy presented with an itchy, disseminated dermatosis of 6 months’ evolution involving the upper trunk, hands, and feet. The dermatitis was exacerbated by exposure to heat and the sun. The physical examination revealed hyperkeratotic, red and yellowish confluent papules and crusts affecting seborrheic areas (Fig 1, A and B). Flat, skin-colored papules were observed on both the dorsal and ventral aspects of the hands and feet (Fig 1, C). Nail discoloration, fragility and a distal V-shaped rupture were also found (Fig 1, D). A Tzanck cytology smear from a crusted lesion on the neck revealed acidophilic, round-shaped keratinocytes and acidophilic bodies resembling pomegranate seeds (Fig 2, A). A biopsy specimen of the skin was obtained, and it revealed suprabasal clefts, acantholysis, and dyskeratosis (Fig 2, B). 1.
What is the most likely diagnosis? A. Familial benign pemphigus (HaileyeHailey disease) B. Transient acantholytic dermatosis (Grover disease) C. Seborrheic dermatitis D. Keratosis follicularis (Darier disease) E. Acrokeratosis verruciformis of Hopf
2.
What is the most likely pathogenic mechanism? A. Obstruction of the sweat ducts B. Mutations in the gene ATP2A2, which encodes the calcium pump SERCA2 C. A primary defect in the calcium pump protein ATP2C1 D. Increased levels of Malassezia spp E. Infection by herpes simplex virus
3.
What is the pathognomonic histopathology finding of this disease? A. Church-spire acanthosis B. Parafollicular accentuation of parakeratosis (‘‘shoulder parakeratosis’’) C. Full-thickness acantholysis resembling a ‘‘dilapidated brick wall’’ D. Spongiosis E. Acantholysis and dyskeratotic keratinocytes (corps ronds and grains) Please visit www.eblueimages.org to answer this question.
From the Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Universidad Aut onoma de Nuevo Le on, Monterrey. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Oliverio Welsh, MD, DrSc, Hospital Universitario ‘‘Dr Jos e Eleuterio Gonzalez,’’ Universidad Aut onoma de Nuevo Le on, Av Francisco I. Madero Pte s/n y Av Gonzalitos s/n,
Col Mitras Centro, Monterrey, Nuevo Le on, Mexico 64460. E-mail: [email protected]. J Am Acad Dermatol 2016;75:e89-90. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.12.012
e89
e90 Garcia-Garcia et al
J AM ACAD DERMATOL
SEPTEMBER 2016
A 10-year-old boy presented with an itchy, disseminated dermatosis of 6 months’ evolution involving the upper trunk, hands, and feet. The dermatitis was exacerbated by exposure to heat and the sun. The physical examination revealed hyperkeratotic, red and yellowish confluent papules and crusts affecting seborrheic areas (Fig 1, A and B). Flat, skin-colored papules were observed on both the dorsal and ventral aspects of the hands and feet (Fig 1, C). Nail discoloration, fragility and a distal V-shaped rupture were also found (Fig 1, D). A Tzanck cytology smear from a crusted lesion on the neck revealed acidophilic, round-shaped keratinocytes and acidophilic bodies resembling pomegranate seeds (Fig 2, A). A biopsy specimen of the skin was obtained, and it revealed suprabasal clefts, acantholysis, and dyskeratosis (Fig 2, B). 1.
What is the most likely diagnosis? A. Familial benign pemphigus (HaileyeHailey disease) B. Transient acantholytic dermatosis (Grover disease) C. Seborrheic dermatitis D. Keratosis follicularis (Darier disease) E. Acrokeratosis verruciformis of Hopf
2.
What is the most likely pathogenic mechanism? A. Obstruction of the sweat ducts B. Mutations in the gene ATP2A2, which encodes the calcium pump SERCA2 C. A primary defect in the calcium pump protein ATP2C1 D. Increased levels of Malassezia spp E. Infection by herpes simplex virus
3.
What is the pathognomonic histopathology finding of this disease? A. Church-spire acanthosis B. Parafollicular accentuation of parakeratosis (‘‘shoulder parakeratosis’’) C. Full-thickness acantholysis resembling a ‘‘dilapidated brick wall’’ D. Spongiosis E. Acantholysis and dyskeratotic keratinocytes (corps ronds and grains) Please visit www.eblueimages.org to answer this question.