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- Presentation
The Hands Will Solve a Mystery
Description
The presentation discusses a 54-year-old woman suffering from painful, scaly, pink, cracked hands, impacting her daily activities for about 20 years. Initial treatments for warts and psoriasis failed, and a diagnosis of poikiloderma was later modified when additional observations, such as reticulated hyperpigmentation in protected areas, emerged. Throughout her treatment at an academic institution, features like longitudinal ridges and V-shaped nicking on her nails were noted. Two skin biopsies eventually indicated lichen sclerosus, leading to considerations of genetic conditions such as Dowling-Degos disease. However, notable symptoms differ from typical cases, such as missing facial and palmoplantar pits. The presenter seeks insight into possible diagnoses including Dowling-Degos, dermatosis, psoriasis, or other undiscovered conditions, highlighting challenges in treatment, particularly with discontinued use of Acitretin. Audience engagement is encouraged to brainstorm possible approaches to her case, including further biopsies and genetic testing, as understanding the underlying condition is crucial for effective management.
View moreConclusions
- The patient presents with long-standing skin issues requiring careful evaluation for diagnosis and treatment.
- Initial treatments for the patient's condition, including topical therapies, were ineffective suggesting a more complex underlying issue.
- Signs of potential genetic skin disorders like Dowling-Degos disease were considered as differential diagnoses because of the patient's unique skin features.
- A biopsy is suggested for a better understanding of the skin condition due to lack of clear clinical-pathological correlation identified previously.
- The patient has exhibited a mix of symptoms that do not fully align with any single diagnosis, indicating a possible unknown or rare skin condition.
- Previous treatments including Acitretin provided some relief, but finding alternatives has been challenging due to adverse reactions to existing medications.
- Consensus among peers indicates uncertainty regarding the exact diagnosis, highlighting the complexity and rarity of the case.
- Wu and Lin J Am Acad Dermatol 2007; 57; 327-34.