Images in Clinical Medicine

Generalized Ostraceous Psoriasis

Salvador Antonio Arias-Santiago, M.D., and Ramón Naranjo-Sintes, Ph.D.

N Engl J Med 2010; 362:155January 14, 2010

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A 47-year-old woman presented to our hospital with a 2-week history of widespread, painful lesions on her trunk and limbs (Panels A and B). Her medical history included hypercholesterolemia, diabetes, and a 10-year history of psoriasis that had been treated with corticosteroids, calcipotriene, and methotrexate. Five months before presentation, the patient's psoriasis went into remission, and treatment was discontinued. Physical examination revealed sharply demarcated, erythematous, well-defined limpetlike plaques covered with scales and crust. Laboratory testing revealed hyperglycemia and hypercholesterolemia. A diagnosis of ostraceous psoriasis was made. The patient was treated with topical petrolatum containing 20% salicylic acid and mometasone furoate cream, resulting in improvement of the lesions after 3 weeks. Adalimumab was then added, with complete resolution of the lesions after an additional 14 weeks.

Salvador Antonio Arias-Santiago, M.D.
Ramón Naranjo-Sintes, Ph.D.
University Hospital of San Cecilio, Granada, Spain
salvadorarias@hotmail.es

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