Case for Diagnosis. Presented by H. H. Roenigk, Jr., MD, and W. Fowler-Bergfeld, MD.
A 28-year-old woman has asymptomatic perifollicular, hyperpigmented, hyperkeratotic lesions distributed over her trunk and the extensor surfaces of her arms and legs of one year's duration. In 1964 she had had a gastric-colic resection for obesity with a subsequent 120 lb weight loss. She had received only occasional vitamin replacement therapy.Biopsy of several lesions showed: (1) hyperkeratotic follicular plugs with minimal periappendageal nonspecific infiltrate (Fig 1), and (2) periappendageal foreign body granuloma (Fig 2).Treatment with Nutraderm and vitamin A, 100,000 units intramuscularly weekly, has produced no change in this condition.Laboratory data included a normal hemogram; vitamin A, 22.5μg/100 cc (normal, 30 to 60); carotene, 5 mg/100 cc (normal, 50 to 250); iron, 20μg (normal, 50 to 150); iron binding capacity, 450 (normal, 300 to 450); lipid profile showed free fatty acids, 6.0 mg
THE CLEVELAND ACADEMY OF DERMATOLOGY. Arch Dermatol. 1969;99(1):116-125. doi:10.1001/archderm.1969.01610190122024