What is the most likely diagnosis? A healthy woman complained of brown spots on her extremities. They began in childhood as fluctuating, migratory erythematous patches that worsened during pregnancy and eventually became fixed and darker. Her brother has similar findings. Topical corticosteroids did not help. Examination found well-defined hyperpigmented plaques with scalloped borders and fine scale symmetrically distributed on her upper arms, medial thighs, elbows, and gluteal cleft (Figs 1 and 2). The thigh plaques had erythematous borders. Palms, soles, nails, hair, teeth, and mucosa were normal. Biopsy found hyperkeratosis, foci of parakeratosis, mild epithelial hyperplasia, papillomatosis, and mild superficial perivascular lymphocytic infiltrate (Fig 3). Potassium hydroxide preparation (KOH prep) and Wood’s lamp examination were negative. (Answer and link in 24h, JAAD Case Reports)
A. Erythrokeratolysis hiemalis
B. Erythrasma
C. Tinea corporis and cruris
D. Erythrokeratodermia variabilis (EKV)
E. Progressive symmetric erythrokeratoderma (PSEK)
