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July 2011

Widespread Papules and Indurated Plaques on a 43-Year-Old Man —Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(7):857-862. doi:10.1001/archdermatol.2011.164-a

A 43-year-old man presented with a history of hoarseness of voice since he was 3 years of age and a progressive development of asymptomatic, multiple pebbly and infiltrated warty skin lesions over his hands (Figure 1), feet, elbows, eyelids, and gluteal region. His face revealed poxlike and acneiform scars on the cheeks, giving him a wrinkled appearance. Pearly beaded papules were present on the upper and lower eyelids. The lowerlabial mucosa showed a yellowish papillary growth. The tongue was woody, with small white papules and fissures (Figure 2). The frenulum was thickened, causing an inability to protrude the tongue. The patient remembered a stage with vesicles and erosions with scarring when he was 10 years old. Laryngeal examination revealed nodular thickening of vocal cords. Results from complete laboratory tests were within reference range. Some histologic changes are shown in Figure 3.

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