Dyskeratosis of the Face: A Quiz.

Acta Derm Venereol 96 © 2016 The Authors. doi: 10.2340/00015555-2207 Journal Compilation © 2016 Acta Dermato-Venereologica. ISSN 0001-5555 A 53-year-old woman presented with a 10-month history of verrucous and hyperkeratotic plaques on the forehead, which had extended progressively to the cheekbones (Fig. 1A). An initial skin biopsy was taken on the cheek, with pathological findings consistent with a diagnosis of warty dyskeratoma (Fig. 1B). In situ human papilloma virus (HPV) hybridization was negative on this biopsy. No improvement was shown after 2 months of acitretin, 25 mg/day. Additional biopsies on the extended lesions of the face identified dyskeratotic cells with some vacuolated keratinocytes evocative of HPV infection. Viral papilloma was suspected and she was treated with shaving, followed by topical application of imiquimod. Four months later, physical examination revealed emaciation, hyperkeratotic, superinfected plaques on the face with a lupoid distribution, erosive lesions on the gums, and vegetant vulvar and perianal lesions. The usual laboratory tests were normal.