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ISSN: 2327-5146
General Medicine: Open Access
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Hyperkeratotic Psoriasis

Abhishek Maiti1* and Avash Das2
1Department of Internal Medicine, The University of Texas Health Science Center at Houston, USA
2Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA
*Corresponding Author : Abhishek Maiti
Department of Internal Medicine
The University of Texas Health Science Center at Houston
2950 Old Spanish Trail
Apt 379, Houston, TX 77054
Tel: 832-696-8407
E-mail: [email protected]
Received March 17, 2016; Accepted March 22, 2016; Published March 24, 2016
Citation: Maiti A, Das A (2016) Hyperkeratotic Psoriasis. Gen Med (Los Angel) 4:i114.doi:10.4172/2327-5146.1000i114
Copyright: © 2016 Maiti A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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A 49 year old woman was brought to the emergency department with altered mental status. Physical examination revealed tachycardia, hypotension. Skin examination showed hyperkeratotic plaques over the dorsum of the hand [Figure 1a], and extensive thickening, scaling, desquamation of the skin, with hyperkeratotic plaques over knees and shins bilaterally [Figure 1b]. She was found to be in septic shock and was admitted to the intensive care unit. After improvement of sepsis, a skin biopsy of the lesions revealed hypogranulosis, confluent parakeratosis, tortuous blood vessels in papillary dermis, suprapapillary plate thinning, Monro’s microabscess, and spongiform pustule of Kogoj which confirmed the diagnosis of hyperkeratotic psoriasis.
Hyperkeratotic psoriasis also referred to as palmoplantar psoriasis is a variant of chronic plaque psoriasis. This has been reported to be a common variant of psoriasis among children, but is very rare in adults [1,2]. Well demarcated lesions, in the absence of other clinical signs of psoriasis, often make the diagnosis of hyperkeratotic psoriasis difficult. Treatment of this subtype has been matter of speculation with emollients being the first line of treatment for dry scales. In case of severe hyperkeratotic palmoplantar psoriasis, either oral methotrexate alone or combination of etanercept and alitretinoin have been demonstrated to be well tolerated and effective treatment options [3-5]. Untreated or refractory patients can present with such extensive lesions.
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