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Oct 2012

Diffuse Hyperkeratosis in a Deaf and Blind 48-Year-Old Woman—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. 2012;148(10):1199. doi:10.1001/archderm.148.10.1199-c

A 48-year-old deaf and blind woman was transferred from an outside hospital for a severe flare of “psoriasis.” Findings from the clinical examination were impressive, revealing diffuse, thick scaling and serum crusting of the scalp with severe, patchy alopecia, and complete absence of the eyelashes and eyebrows. She had generalized mild erythroderma with massive cobblestone-like hyperkeratotic plaques of the trunk and extremities. Her palms demonstrated a diffuse grainy keratoderma, and her soles had extensive hyperkeratosis with deep fissures (Figure 1). Her corneas were opaque, and she had thick scaling on the face with perioral radial fissures (Figure 2). No mucosal lesions were seen. We further discovered that her skin disease and deafness were congenital, but her vision loss had been progressive into her 20s, when she underwent a corneal transplant that was unsuccessful. Two punch biopsies were performed and stained with hematoxylin-eosin and periodic acid–Schiff (PAS) (Figure 3).

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