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Picture of the Month—Quiz Case

Picture of the Month—Quiz Case A 4-year-old boy born in Jamaica presented to the emergency department with a 2-year history of intermittent “rash.” His mother described red scaly patches affecting only the palms of his hands and the soles of his feet, and he was brought in for evaluation secondary to an acute increase in itching and pain. The patient had been scratching the lesions to the point of skin breakdown, and he had been less inclined to bear weight on his feet secondary to pain. The family had been using topical over-the-counter hydrocortisone acetate cream and oral antihistamines without significant effect. They noted periods when the skin lesions improved but no period of true skin clearing over the past 2 years. He had no recent fevers, weight loss, joint pain, dental issues, or mucous membrane lesions. There was no family history of any dermatologic condition. Results of his physical examination revealed diffuse erythema with scaly yellow-brown plaques on the volar aspects of the hands and the plantar aspects of the feet (Figures 1 and 2). There were areas of fissuring with minimal bleeding. The remainder of the cutaneous examination was remarkable only for a small white scaly patch on his chest and for his having dystrophic fingernails and toenails with some evidence of pitting. His hair and teeth were normal. Figure 1. View LargeDownload Photograph of the hands revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures. Figure 2. View LargeDownload Photograph of the feet revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures. What is your diagnosis? SECTION EDITOR: SAMIR S. SHAH, MD, MSCE http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Picture of the Month—Quiz Case

Abstract

A 4-year-old boy born in Jamaica presented to the emergency department with a 2-year history of intermittent “rash.” His mother described red scaly patches affecting only the palms of his hands and the soles of his feet, and he was brought in for evaluation secondary to an acute increase in itching and pain. The patient had been scratching the lesions to the point of skin breakdown, and he had been less inclined to bear weight on his feet secondary to pain. The family had been...
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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpediatrics.2011.875a
Publisher site
See Article on Publisher Site

Abstract

A 4-year-old boy born in Jamaica presented to the emergency department with a 2-year history of intermittent “rash.” His mother described red scaly patches affecting only the palms of his hands and the soles of his feet, and he was brought in for evaluation secondary to an acute increase in itching and pain. The patient had been scratching the lesions to the point of skin breakdown, and he had been less inclined to bear weight on his feet secondary to pain. The family had been using topical over-the-counter hydrocortisone acetate cream and oral antihistamines without significant effect. They noted periods when the skin lesions improved but no period of true skin clearing over the past 2 years. He had no recent fevers, weight loss, joint pain, dental issues, or mucous membrane lesions. There was no family history of any dermatologic condition. Results of his physical examination revealed diffuse erythema with scaly yellow-brown plaques on the volar aspects of the hands and the plantar aspects of the feet (Figures 1 and 2). There were areas of fissuring with minimal bleeding. The remainder of the cutaneous examination was remarkable only for a small white scaly patch on his chest and for his having dystrophic fingernails and toenails with some evidence of pitting. His hair and teeth were normal. Figure 1. View LargeDownload Photograph of the hands revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures. Figure 2. View LargeDownload Photograph of the feet revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures. What is your diagnosis? SECTION EDITOR: SAMIR S. SHAH, MD, MSCE

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Apr 1, 2012

Keywords: erythema,foot,hand,keratosis,fissure,weight reduction,pain,skin disorders,exanthema,antihistamines,arthralgia,physical examination,fever,drugs, non-prescription,examination of skin,hemorrhage,pruritus,skin lesion,impaired skin integrity,hydrocortisone acetate

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