REPORT OF A CASE
A 50-year-old man was evaluated for a chronic dermatitis with summer exacerbations. The patient reported that the problem lasted for 38 years. His son also had chronic dermatitis.Findings from the physical examination revealed hyperkeratotic, exudative, and malodorous vegetations on both sides of his legs (Fig 1). In addition, he had numerous brown keratotic follicular papules on his trunk (Fig 2).Laboratory studies were not contributory. A microbiological culture of the leg lesions yielded Staphylococcus aureus. The histopathologic appearance of the verrucous lesion of his leg is shown in Fig 3.What is your diagnosis?
Darier's disease, cornifying type.
The epidermis showed hyperkeratosis, acanthosis, and papillomatosis. Also seen were suprabasal clefts around preserved papillae (villi), acantholytic cells in lacunae, corps ronds and grains in the horny layer, and a chronic inflammatory infiltrate in the upper dermis.
Rongioletti F, Cestari R, Rebora A. Verrucous and Malodorous Vegetations on the Legs. Arch Dermatol. 1992;128(3):402. doi:10.1001/archderm.1992.01680130117019