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By Lawrence A. Schiffman, DO, Yanni Ni,
MD, and Stephen M. Schleicher, MD
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CASE:
An 86-year-old resident of a nursing home has a chronic blistering
rash on her hands and feet. She has multiple medical problems
and is on several oral medications. Examination of her palms
and soles reveals scattered flattened bullae and slightly
indurated, well-demarcated, erythematous plaques. Several
nails manifest dystrophy and hyperkeratosis, and coarse scales
of her scalp are noted as well.
WHAT IS YOUR DIAGNOSIS?
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The patient has acral pustular psoriasis. An uncommon variant
of psoriasis, this chronic condition is characterized by brightly
erythematous plaques and pustules, the latter sterile in nature.
The nails are frequently affected. Adequate control may require
administration of systemic agents such as acitretin, cyclosporine,
and methotrexate. A combination of oral psoralen and ultraviolet
light (PUVA) may also prove beneficial, as may the so-called
"biologics" etanercept, efalizumab, and alefacept. |
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Dr. Schiffman is a fellow at DermDx Centers
for Dermatology of Northeastern Pennsylvania, headquartered
in Hazelton. Dr. Ni is a visiting physician and a graduate
of the Beijing Medical University in Beijing, China. 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 37(76):29-30, 2005
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