Circumscribed palmar hypokeratosis: clinical evolution and ultrastructural study after prolonged treatment with topical calcipotriol

Circumscribed palmar hypokeratosis is a recently described condition that consists of a solitary area of depressed skin affecting the palm (or sole). Its histo pathological features include a thinned horny layer, a slightly diminished granular cell layer, and intraepidermal vacuolated cells. Prolonged treatment with topical calcipotriol resulted in complete recovery of the affected zone in the case reported here. A second biopsy of the lesion taken at around the fourth year of therapy showed a normalization of the granular layer, a reduction in the intraepidermal vacuolated cells, and a somewhat thicker horny layer. An ultrastructural study carried out at the same time showed a reduction in keratin bundles and keratohyalin granules, and an increase in lipid droplets up to the horny layer. These findings and the therapeutic response to topical calcipotriol support the concept that circumscribed palmar hypokeratosis is a focalized abnormal keratinization defect morphologically expressed at the granular and horny layers

Bazex Syndrome (Acrokeratosis Paraneoplastica) Diagnosed in a Patient with Oral Persistent Ulcerations

Paraneoplastic syndromes associated with head and neck cancer are rare and have been reported under dermatological, endocrine, hematological, neurological and rheumatological disorders. Bazex syndrome is an intriguing paraneoplasia that can be associated with head and neck squamous cell carcinomas. A range of symmetrical dermatological manifestations, with a clear predilection to extremities, that encompasses erythematous squamous plaques, skin scaling and nail dystrophy can provide a psoriasiform pattern in Bazex syndrome. In addition to these tricky clinical features, the rarity of the disease and the lack of understanding on Bazex syndrome generally make such cases to be mismanaged as psoriasis or lichen planus, causing an important delay in the diagnosis of the underlying malignancy. The authors describe a case of Bazex syndrome that occurred in a patient with a recently diagnosed tongue squamous cell carcinoma. Clinicians should consider paraneoplasia when assessing skin and/or oral persistent lesions