Psoriasiform Dermatitis in a Cachectic Man

Abstract

REPORT OF A CASE A 43-year-old man was admitted to the Brooklyn (NY) Veterans Administration Medical Center for workup of anorexia, 18-kg weight loss, anemia, and a rash. His dermatosis had begun two months earlier on his soles, with subsequent spread to his palms, periungual region of multiple nails, groin, lower back, and flexor surface of the lower extremities. Previous treatment with topical steroids and antifungal creams had been unsuccessful. Physical examination revealed markedly hyperkeratotic soles with some pustules (Fig 1). The palms had several discrete, red, scaly papules and pustules. All ten toes and several fingers showed periungual violaceous erythema and scaling (Figs 2 and 3). The involved digits showed hyperkeratosis and dystrophy of the nails. Onycholysis was present along with loss of several nails. There were erythematous, scaly, sharply demarcated plaques on the inner thighs, lower back, and buttocks. Additional physical findings included a 1 × 0.5-cm ulcer