Darier DiseaseA 60-year-old woman presented with a generalized pruritic rash since adolescence. She reported her son had a similar rash. Physical examination revealed greasy brown and keratotic papules and plaques in a seborrheic distribution, which included her chest, back, forehead, scalp margins, and ears (Figures 1 and 2). Histopathology revealed acantholytic dyskeratosis. The clinicopathological features along with the patient’s family history were consistent with Darier disease. The patient’s skin disease markedly improved with acitretin.
Hansen Disease (Leprosy)A 77-year-old man with psoriatic arthritis, on methotrexate, presented with asymptomatic skin lesions. He denied altered sensation within the lesions and history of international travel, but he reported previously cleaning out suspected armadillo burrows. Physical examination revealed pink, smooth, annular, and cyclic papules and plaques on the extremities and back (Figures 1 and 2). Histopathology showed clusters of acid-fast staining organisms within foamy histiocytes in the dermis (Supplemental Figure, available online at http://www.mayoclinicproceedings.org ).