以掌跖角皮症为首发表现的银屑病

Palmoplantar keratoderma presents as its initial manifestation of psoriasis

报告1例以掌跖角皮症为首发表现的银屑病。患者男,19岁。手足红斑伴鳞屑40 d,加重10 d。皮肤科检查:头皮、口周、肛周、阴囊、腋下、背部及手足大片浸润性斑片,其上见成层鳞屑,Auspitz征阳性,部分鳞屑呈蛎壳样,掌跖部皮损融合成片,呈疣状增生,指、趾甲浑浊增厚。手掌部皮损组织病理检查:表皮角化过度伴角化不全,棘层肥厚,表皮突延长,颗粒层消失,真皮浅层血管周围淋巴细胞浸润。诊断:银屑病。治疗:予口服阿维A,治疗20 d后皮损基本消退。

A case of palmoplantar keratoderma as the first manifestation of psoriasis is reported. A 19-year-old male pre- sented with palmoplantar erythema and scaling for 40 days, worsening for 10 days. The clinical manifestations included ery- thema and scaling plaques on the scalp, around the mouth, perianus, scrotum, armpits, back, hands and feet. Some of lesions were covered with crusts. Auspitz sign was positive. Nail was thickened and discolored. Histopathological examination showed epidermal hyperkeratosis, parakeratosis, acanthosis, elongation of epidermal rete ridge, disappearance of granular layer, and perivascular infiltration of lymphocytes in the upper dermis. The diagnosis of psoriasis was made. After 20 days of treatments with oral acitretin, lesions almost disappeared.