Psoriasiform lesions on trunk and palms

Jennifer Clay Cather, MD, John Christian Cather, MD, and M. Alan Menter, MD

From the Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center (Jennifer Cather and Alan Menter), and Texas Dermatology Associates (all authors), Dallas, Texas.

Corresponding author: Jennifer Clay Cather, MD, 5310 Harvest Hill Road, Suite 260, Dallas, Texas 75230.

A 34-year-old man presented with a 2-week history of a relatively asymptomatic truncal rash with gradual spread to involve his face, limbs, palms, and soles. Approximately 10 days before onset of the rash, he experienced a flulike episode with mild arthralgias, sore throat, and mild headache that had reappeared intermittently prior to his evaluation.

Physical examination revealed a healthy looking man with a diffuse papular eruption and minor associated scaling involving the trunk and limbs (Figures 1 and 2) with discrete erythematous lesions on the palms and soles (Figure 3). The patient had mild scalp scaling, mild photophobia, and a moderate degree of adenopathy, especially in the groin and posterior neck.

What is your diagnosis, and what lab evaluations may be helpful in the diagnosis?