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By Jeffrey A. Dunkerly, DPM, and Stephen M. Schleicher, MD
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CASE:
A 63-year-old man with a history of polio causing unilateral foot deformity complains of intermittent pain in the affected foot. His medical history is also significant for hypertension, type 2 diabetes, and peripheral neuropathy. Besides the obvious deformity of his foot, a physical examination finds a lesion on the anterior tibial area as well. The patient tells you that the plaque has been slowly enlarging for the past 18 months but is asymptomatic. Punch biopsy reveals prominent cornoid lamellae.
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The patient exhibits porokeratosis of Mibelli, which is characterized by abnormal keratinization presenting as a well-circumscribed, annular plaque ranging in size from a few millimeters to several centimeters. The central portion may be atrophic. These lesions are most common on the lower extremities and can be distinguished histologically by cornoid lamellae. Because the disorder tends to be autosomal dominant, many cases develop in childhood, while others arise sporadically during times of immunosuppression. Treatment options include liquid nitrogen, fluorouracil, calcipotriol, and imiquimod; response is variable. |
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Dr. Dunkerly is an associate with Martin Foot and Ankle in York, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(10):27-28, 2008
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