Epidermal Verrucal Lesion with Velvety-Like Granular Surface at Female External Genitalia and Medial Aspect of the Thigh Compatible with Previous History of Longstanding Psoriasis : A Case Report

Abstract

Psoriasiform dermatoses are a wide spectrum of inflammatory diseases, with several major forms represented by different clinical entities. Psoriasis is the prototype of psoriasiform dermatoses. Other conditions include pustular psoriasis, Reiter’s syndrome, pityriasis rubra pilaris, lichen simplex chronicus and large-plaques parapsoriasis. These lesions represent a diagnostic challenge, both on clinical and histopathological basis. This could be attributed to overlapping clinical and histopathological features. All of them share the hyperactivity of keratinocytes leading to extensive hyperkeratosis, orthokeratosis, congestion and perivascular lymphocytic infiltration.

We presented a 25 years old female patient. She complained of epidermal verrucal lesion at the external genitalia and medial aspect of the thigh and pubic region. The surface of the skin was rough with variable velvety like granular surface from one area to another. The cut section showed marked thickening of the epidermis with upper dermal congested vessels. This lesion was compatible with the previous history of long-standing psoriasis. A wide local excision was performed with closure of the wide area with minimal scar. The specimen was sent for histopathological examination and it revealed a picture of psoriasiform dermatitis.