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HYPERKERATOTIC FORM OF POROKERATOSIS OF MIBELLI

A 16-year-old black woman gave a history of multiple skin lesions on her trunk and extremities with a sudden onset and rapid extension within the last 5 weeks. She had been pregnant for 3 months. She denied having any members of her family similarly affected. Physical examination revealed a healthy woman with multiple, slightly pruritic, verrucous nodules and brownish ring-shaped plaques (Fig. 1). The lesions were scattered on the trunk and extremities. Biopsy specimens for light microscopy were obtained from a verrucous nodule on the right arm and from a flat hyperpigmented circular lesion with elevated rim on the left arm. Sections from both types of lesions showed a thick horny plate consisting of alternating areas of orthoand parakeratosis. Several cornoid lamellae were present in the section (Fig. 2). The cornoid lamellae were seated deeply in the epidermis in bowl-shaped indentations. They were not connected with adnexae. The granular layer was absent beneath the parakeratotic columns and was normal or increased in thickness in the areas adjacent to the indentations. Numerous round or oval, dyskeratotic eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the parakeratotic columns (Fig. 3). Corps rondslike homogenous bodies were found at the lower portion of the cornoid lamellae. The epidermis was acanthotic with irregularly thickened and elongated rete ridges. A lymphohistiocytic infiltrate was present in the papillary dermis and around the blood vessels and adnexae in the mid and lower dermis. Incontinence of pigment was seen in the papillary dermis. Several papillae contained grossly ectatic capillary loops (Fig. 4).