Diagnose this zebra: A differential diagnosis case
By Cheryl Guttman Krader | Reviewed by Seemal R. Desai, MD
Case history
A 58-year-old woman of Indian origin presented with a chronic, hyperkeratotic, verrucous eruption on the bilateral lower extremities. The lesions covered the dorsal aspect of the feet and toes and extended to just above the ankles. Erosions and flaccid bullae were also seen along with areas of erythema, scarring, and hypopigmentation. Toenail dystrophy was present as well.
The patient reported that the condition was pruritic and developed with an acute onset approximately 6 to 8 months earlier. There were no other remarkable findings on skin examination or medical history.
The patient was prescribed topical triamcinolone acetonide 0.1% ointment twice daily along with emollients and was scheduled for a follow-up visit in 1 month. On return, the lesions were only mildly improved.
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