December 29th, 2000
is a 56 year old woman with a one year history of a progressing lesion
on the right leg. Over the past couple of months she has developed
similar but less advanced lesions on the right palm and on the arms.
The leg lesion began in 12/99 as a plaque R leg and has grown centrifugally.
She is in good general health and takes no medications other than
"herbs." Lives with husband and they run an inn and restaurant. She
has been worked up by a very competent dermatologist with lab, cultures
and biopsy - all with non-conclusive findings.
is a large patch on the right anterior leg which measures ~ 15 cm
in diameter. The most significant aspect is the presence of deep-seated
pustules. The surface is glazed and there is some crusting, especially
around the periphery. She has similar but much less pronounced lesions
on the right palm and on the arms.
is uniform psoriasiform epidermal hyperplasia, parakeratosis, thinning
of the suprapapillary plates, spongioform pustules within the epidermis
and cornified layer and a superficial mixed inflammatory inflitrate
in the papillary dermis. PAS stain negative for fungi. The histologic
pattern is consistent with pustular psoriasis.
was started on Methotrexate 12.5 mg per week and halobetasol proprionate
0.05% ointment bid.
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