Progressive symmetrical erythrokeratodermia - Case report
Female patient, 55 years old, phototype III, referred the onset of skin lesions from the age of 5, with progressive growth until the age of 18. She reports that similar lesions in the same locations also occurred on three of her siblings during their childhood. Their parents were not consanguineous. Dermatological exams evidenced fixed, finely scaly, symmetric erythematous keratotic plaques on the dorsum of the hands, interphalangeal pads, wrists, elbows, groin and feet (,,,). The plaques were thicker on the elbows and there was a welldefined, brownish-colored hyperpigmentation halo on the inguinal region. A biopsy of the dorsum of the right foot revealed discrete papillomatosis and acanthosis, orthokeratotic hyperkeratosis in a basket-weave pattern and maintenance of the granular layer, thus eliminating the main hypothesis of psoriasis (). For treatment, topical 0.025% tretinoin associated with 20% urea and 3% salicylic acid was applied, as well as moisturizing lotion in the morning. After 4 months' treatment only mild clinical improvement was noticed and 20mg/day acitretin was introduced, with excellent response.