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Special Feature |

Picture of the Month—Quiz Case FREE

Stephanie Albin, MD; Leslie Castelo-Soccio, MD, PhD
[+] Author Affiliations

Author Affiliations: Pediatrics Residency Program (Dr Albin) and Department of Dermatology (Dr Castelo-Soccio), Children's Hospital of Philadelphia, Pennsylvania.


SECTION EDITOR: SAMIR S. SHAH, MD, MSCE


Arch Pediatr Adolesc Med. 2012;166(4):377. doi:10.1001/archpediatrics.2011.875a.
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A 4-year-old boy born in Jamaica presented to the emergency department with a 2-year history of intermittent “rash.” His mother described red scaly patches affecting only the palms of his hands and the soles of his feet, and he was brought in for evaluation secondary to an acute increase in itching and pain. The patient had been scratching the lesions to the point of skin breakdown, and he had been less inclined to bear weight on his feet secondary to pain. The family had been using topical over-the-counter hydrocortisone acetate cream and oral antihistamines without significant effect. They noted periods when the skin lesions improved but no period of true skin clearing over the past 2 years. He had no recent fevers, weight loss, joint pain, dental issues, or mucous membrane lesions. There was no family history of any dermatologic condition. Results of his physical examination revealed diffuse erythema with scaly yellow-brown plaques on the volar aspects of the hands and the plantar aspects of the feet (Figures 1 and 2). There were areas of fissuring with minimal bleeding. The remainder of the cutaneous examination was remarkable only for a small white scaly patch on his chest and for his having dystrophic fingernails and toenails with some evidence of pitting. His hair and teeth were normal.

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Figure 1. Photograph of the hands revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures.

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Figure 2. Photograph of the feet revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures.

Figures

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Graphic Jump Location

Figure 1. Photograph of the hands revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures.

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Graphic Jump Location

Figure 2. Photograph of the feet revealing thick, hyperkeratotic plaques with associated erythema, scaling, and fissures.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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