Erythematous Plaque on the Palm
Erythematous Plaque on the Palm
A 60-year-old white man.
The patient presented with a slowly enlarging, minimally pruritic, erythematous plaque that had been present on the palm of his right hand for more than 20 years. Over the years, the patient has been seen by several physicians for this problem. He recalled treatment for eczema with topical steroids and for ringworm with topical antifungals. He reported partial improvement with each treatment but a return to the pretreatment state soon after therapy was discontinued.
There was no history of similar lesions elsewhere on the body. The patient was in good general health. His only medication was ranitidine for occasional esophageal reflux. He had no medication allergies. He worked as a computer technologist and did not report a history consistent with environmental exposure to allergens or irritants on the hands. There was no history of arsenic exposure or internal or cutaneous malignancies.
On the right palm, near the thenar eminence, there was a 3.1 x 2.7 cm erythematous scaly plaque with sharp borders (Figure 1). There were increased palmar markings and a suggestion of lichenification. There was no palpable adenopathy of the extremity or axilla. The remainder of the exam was unremarkable.
(Enlarge Image)
Figure 1.
Erythematous scaly plaque. (Photo courtesy of Dr. Stasko)
A thick stratum corneum with parakeratosis overlies an acanthotic epidermis (Figure 2). Within the epidermis, there are numerous atypical keratinocytes. Scattered mitotic figures are present. In the dermis, a lymphocytic inflammatory infiltrate is present.
(Enlarge Image)
Figure 2.
Histopathology. (Photo courtesy of Dr. Stasko)
What is your diagnosis?
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Clinical Presentation
Patient
A 60-year-old white man.
History
The patient presented with a slowly enlarging, minimally pruritic, erythematous plaque that had been present on the palm of his right hand for more than 20 years. Over the years, the patient has been seen by several physicians for this problem. He recalled treatment for eczema with topical steroids and for ringworm with topical antifungals. He reported partial improvement with each treatment but a return to the pretreatment state soon after therapy was discontinued.
There was no history of similar lesions elsewhere on the body. The patient was in good general health. His only medication was ranitidine for occasional esophageal reflux. He had no medication allergies. He worked as a computer technologist and did not report a history consistent with environmental exposure to allergens or irritants on the hands. There was no history of arsenic exposure or internal or cutaneous malignancies.
Physical Examination
On the right palm, near the thenar eminence, there was a 3.1 x 2.7 cm erythematous scaly plaque with sharp borders (Figure 1). There were increased palmar markings and a suggestion of lichenification. There was no palpable adenopathy of the extremity or axilla. The remainder of the exam was unremarkable.
(Enlarge Image)
Figure 1.
Erythematous scaly plaque. (Photo courtesy of Dr. Stasko)
Histopathology
A thick stratum corneum with parakeratosis overlies an acanthotic epidermis (Figure 2). Within the epidermis, there are numerous atypical keratinocytes. Scattered mitotic figures are present. In the dermis, a lymphocytic inflammatory infiltrate is present.
(Enlarge Image)
Figure 2.
Histopathology. (Photo courtesy of Dr. Stasko)
What is your diagnosis?
Contact dermatitis.
Tinea manuum.
Squamous cell carcinoma in situ (Bowen's disease).
Atopic dermatitis.
View the correct answer.