LAUSR

Journal Compilation © 2020 Acta Dermato-Venereologica. doi: 10.2340/00015555-3560 A 53-year-old man was referred with a 7-year history of erythematous patches and plaques containing scales and fissures. This condition had been present on both palms and the left sole, and, over the past 2 years, it had progressed to involve the nails. The eruption had been asymptomatic, except for occasional episodes of pruritus. For several years he had been diagnosed with eczema and was treated with topical corticosteroids that yielded only suboptimal improvements. Over the past 10 days, he noticed the appearance of numerous small pustules with a yellowish crust that were confined to the palms and soles. His medical and family history were unremarkable. Physical examination revealed well-demarcated darkreddish plaques with adherent crusts, occasional erosion and fissuring, involving both palms and surfaces of fingers as well as the left sole. In addition, a dystrophy and yellow discoloration was present in several finger nails (Fig. 1a, b). Fungal examination was negative and routine blood tests and imaging examinations were normal. An initial diagnosis of palmoplantar pustulosis was formulated. A skin biopsy showed hyperkeratosis with dense infiltration of atypical lymphocytes lining the dermo-epidermal junction and partial lymphocytes infiltrating into the epidermis forming Pautrier’s microabscesses (Fig. 1c). Immunohistochemical staining revealed that intraepidermal lymphocytes were positive for CD3, CD4, but negative for CD7, CD8, and CD20.