Figure 1. A) Psoriasis in scanning magnification: confluent parakeratosis, neutrophils in the cornified layer (Munro’s microabscesses), absent granular layer, long and thin rete ridges, with thin suprapapillary plates. B) PRP in scanning magnification: alternating parakeratosis and orthokeratosis in a chessboard pattern, preservation of the granular zone and thick epidermal suprapapillary plates.
A Confluent parakeratosis Thin suprapapillary plates
Absent granular zone
Granular zone Thick suprapapillary plates
Figure 2. A) Psoriasis in high power: Presence of neutrophils in the area of compact parakeratosis and dilated capillaries in dermal papillae. B) PRP in high power: Parakeratosis alternating with orthokeratosis (chessboard pattern), prominent granular zone and thick suprapapillary plates.
Pityriasis rubra pilaris is much less common than psoriasis, has a characteristic abrupt onset and rapidly becomes widespread (specially the acquired form). Furthermore, unlike psoriasis, which tends to persist for many years unless the patient receives therapy, PRP usually remits within one to three years of its onset. doi:10.1684/ejd.2014.2360
Residents’corner April 2014. Nail it!: Eye-catching nail folds Kristina BUDER, Henning HAMM Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 WÜRZBURG, Germany e-mail: [email protected]
A 62-year-old male patient was referred with a 6-month history of an erythematous face and hands. He complained EJD, vol. 24, n◦ 2, March-April 2014
about fatigue and particularly weakness of his shoulders and upper arms since 6 weeks. On clinical examination he presented with deep-red facial erythema sparing the perioral region, significant periorbital oedema, purple erythema on his décolleté, erythematous macules and papules on the dorsal aspect of his fingers, especially over the bony prominences, and periungual erythema. Prominent nail fold changes comprised telangiectasia, haemorrhages and hyperkeratotic cuticulae (ﬁgure 1). Neurological examination revealed symmetric proximal paresis of the upper arms. The clinical diagnosis of dermatomyositis was confirmed by markedly elevated creatinine phosphokinase of 3879 U/L (norm