Asymptomatic annular lesions on face and hands

Submitted by Khalil Alhamdi M.D.
Associate Professor of Dermatology
Basrah, Iraq

Abstract: A 25-year old woman with 3-year history of asymptomatic annular lesions on face and hands

History: A 25-year-old woman presented with 3-year history of multiple asymptomatic annular lesions involving the face and the dorsa of both hands that gradually increase in size. She had received different modalities of treatment without improvement.

O/E: Young aged women presnted with multiple asymptomatic annular atrophied hyperpigmented patches with hyperkeratotic border that affect the face in a mask-shaped destribution and the dorsa of both hands.

Clinical Photo:

Lab: All relevant investigations were normal.

HPE: revealed features suggestive of porokeratosis

Diagnosis: Porokeratosis of Mibelli

Comments: This woman was misdiagnosed as fungal infection and lichen planus for which she received treatment without benefit. On clinical and histopathological bases we put her on topical 5Fu in addition to irregular courses of isotretnion because of poor compliance and inavailability of the latter drug in our country.

Questions:

1. What is the experience of our colleagues in seeing such unusual presentation?
2. What is your treatment suggestion to help this poor lady.