Advances in and venereology ActaDV Acta Dermato-Venereologica ActaDV Histopatho­ (1:160, speckledpattern),anti-dsDNA and anti-SSA/Ro. telet number (92×10 20 years. Laboratory examinations revealed reduced 1B). The lesionshadgraduallyincreasedoveraperiodof 1A–E), and poikiloderma over his fingers and left ear (Fig. metacarpophalangeal joints,theleftear, rightheel(Fig. verrucous nodulesonthedorsaofinterphalangealand on hislips,asymptomatic,round,discrete,hyperkeratotic, A 50-year-old manpresentedwithhyperkeratoticscales # 1 Youming MEI Distinct HyperkeratoticLesionsonAcralSkin andLips:AQuiz Laboratory of Molecular Biology for Skin Diseases andSTIs, Nanjing, China. E-mail:[email protected] Journal Compilation ©2018ActaDermato-Venereologica. This isan open access article under the CC BY-NC license.www.medicaljournals.se/acta Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, 210042, and These authorscontributed equally tothis work. logy of biopsiedfoot lesions revealed marked 1# , Zhiming CHEN 9 /l), positive antinuclear antibodies 1# , Wei ZHANG 1,2 , Jingshu XIONG QUIZ SECTION pla 1 andHongsheng - What isyourdiagnosis?Seenextpageforanswer. the lesionsbecamefatter. cream b.i.d. for 1 month, the patient reported that most of mg and viaminate 50mg b.i.d., topical 0.05%halometasone methylprednisolone, 8mgq.d.,hydroxychloroquine100 IgG andcomplement3wasnegative. After treatmentwith of immunofluorescence Direct 1G). (Fig. mid- and in the upper dermis, and mucin deposition in the superficial lympho­ was There , acanthosisandhypergranulosis (Fig.1F). WANG 1,2 cyte infiltration around the vessels and vessels the around infiltration cyte magnification: (F)×50,(G)×200. and mucin deposition in the dermis (arrow demonstrating lymphocyte infiltration) (arrowhead aspects of the rightheellesion, Histopathological the poikiloderma (arrow) on the left ear. (F, G) D) Hyperplastic plaques on the lips, nodule and metacarpophalangeal joints, and right . (C, and and on nodules the interphalangeal Fig. 1. (A, B, E) Verrucous hyperplastic plaques Acta DermVenereol 2018;98: 475–476 doi: 10.2340/00015555-2879 2 Jiangsu Key ), original ), original 475 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV www.medicaljournals.se/acta acid andp-amino-benzoicethylester(11). Clinically, of retinoid, which was prepared from all-trans retinoid roids andviaminatefor1month. Viaminate isaderivative combination ofhydroxychloroquine,low-dosecorticoste (8–10). The current case was treated effectively with a lure hadalsobeenreportedsoonafterthestartoftreatment and safety in the treatment of HLE, fulminant hepatic fai hydroxychloroquine has been proven to have good efficacy long-term follow-upareimportantforpatientswithDLE. ment ofclinicalmaterialandsystemicexaminations, Taking allthesefactorsintoconsideration,overallassess transform to squamous cell carcinoma after some years(7). progression to SLE (6). Unhealed lesions of CLE may also and anti-dsDNA antibodiesmaybepositivepredictorsfor neck, anaemia, leucopaenia, positive antinuclear antibodies precedes SLE(5,6). Widespread DLElesionsbelowthe while upto45.7%ofdiscoidlupuserythematosus(DLE) sign ofSLE,whichappearsin25%patientswith first the be can CLE (4). criteria Clinics Collaborating nal classification criteria and 2012 Systemic Internatio according tothe1997 American CollegeofRheumatology (SLE) erythematosus lupus systemic for criteria the filled positive antinuclearantibodyandanti-dsDNA,whichful reducedplateletcounts, hypertrophiclesions, distinctive nosis wasmadeprincipallybasedonthecombinationof effect ofhydroxychloroquinesuggestHLE. This diag heel. However the immunological disorder and the good knuckle-pads, andwartsonthehandscallus nus andseveralotherhyperkeratoticconditions,suchas manifestations closely resemble hypertrophic lichen pla it fromsquamouscellcarcinoma. The patient’s clinical revealed no signs of keratinocyticatypia, differentiating having lupusviapathology. Histopathology ofafootlesion HLE, thepatientcouldnotbeconclusivelyinterpretedas hyperkeratosis is characteristic and helpful for diagnosis of of classicCLE(3). Although themanifestationofmarked features with associated hyperplasia marked hyperkeratosis mechanisms (1,2). The primaryhistologicalchangeis been reportedpreviouslyanditseemstoariseviathesame literature (1). The similarity with cutaneous lesions has lips ororal mucosa lesions is seldom mentioned in the chronic cutaneouslupuserythematosus(CLE).HLEwith Hypertrophic lupuserythematosus(HLE)isavariantof Diagnosis: Acta Derm Venereol 2018;98:475–476. and Lips:ACommentary Distinct HyperkeratoticLesionsonAcralSkin 476 HLE areoftenchronicandrefractorytodrugs. Although Quiz: Diagnosis Hypertrophic lupuserythematosus ANSWERS TOQUIZ ------

12. 10. ACKNOWLEDGEMENTS of thiscombinationintreatmentHLE. However, clinicaltrialsareneededtoassessthefulleffects example, acitretin,butwithlesstoxicside-effects (11, 12). viaminate appearstopossessthetherapeuticeffects of,for 11. REFERENCES Jiangsu ProvinceofChina(BK20141065). of China(81371751),andtheNaturalScienceFoundation (CIFMS-2016-I2M-1-005), National Natural Science Foundation demy ofMedicalSciencesInnovationFundfor This manuscriptwassupportedbygrantsfromtheChinese Aca 3. 8. 6. 2. 4. 9. 7. 5. 1. Arps DP, Patel RM. Cutaneous hypertrophic lupus erythe Al-Mutairi N,Rijhwani M,Nour-Eldin O. Hypertrophic lupus Makin AJ, Wendon J, Fitt S, Portmann BC, Williams R. Fulmi James JA, Kim-Howard XR, Bruner BF, Jonsson MK, McClain Chong BF, SongJ, NJ. Olsen factorsfordeve risk Determining Marcello MentaS.Marcello Nico, V. Silvia Lourenço. Hypertrophic Amezcua-Guerra LM, Higuera-Ortiz V, U, Arteaga-García Cao L, Zheng F, Ma P, Liu W, Sun D, Chen X, et al. LC- Yoshimoto N, Shinkuma S, Ujiie H, Nomura T, Fujita Y, Abe R, Ee HL, Ng PP, Tan SH, Goh CL. Squamous cell carcinoma Ribero S, SciasciaS, Borradori L,Lipsker D. Thecutaneous Daldon PE,MacedodeSouzaE,Cintra ML.Hypertrophiclupus therapy. J Dermatol 2005;32: 482–486. erythematosus treated successfully with acitretin as mono­ is associated with later onset of systemic lupus erythemato MT, Arbuckle MR, et al. Hydroxychloroquine sulfate treatment 93: 108–109. Venereol2013; Derm Acta cases. 4 of series a cavity: oral (verrucous) cutaneous of the lip and 1997 American College of Rheumatology classification crite Systemic LupusInternationalCollaborating Clinicsandthe 2012 the of Hübbe-TenaPerformance S, C. Gallegos-Nava 46:701–706. 2008; Sci Chromatogr J rats. to administrations oral after APCI-MS-MS method for the tissue distribution of viaminate with hydroxychloroquine. JDermatol 2017; 44: e48–e49. treated erythematosussuccessfully lupus Hypertrophic et al. Dermatol 2006; 31: 542–544. erythematosus: the need for continued surveillance. Clin Exp developing in two Chinese patients withchronic discoid lupus 2017; 53: 291–305. spectrum of lupus erythematosus. Clin Rev Allergy Immunol Cutan Pathol 2003; 30: 443–448. J cases. 14 of study clinicopathological a erythematosus: 137: 1205–1210. 2013; Med PatholLab Arch information. clinical of absence the in diagnosis histopathologic challenging a matosus: 1994; 35: 569–570. Gut hydroxychloroquine. to secondary failure hepatic nant sus. Lupus2007; 16: 401–409. lupus erythematosus. Br JDermatol 2012; 166: 29–35. loping systemic lupus erythematosus in patients with discoid Arthritis Care Res (Hoboken) 2015;67:437–441. ria for systemic lupus erythematosus in a real-life scenario. ------