Bilateral Burning Palmoplantar Lesions

Abstract

A 59-year-old woman presented with atrophic, hypopigmented, ivory papules and plaques localized to the central palms and soles of 3 years' duration. The lesions were associated with burning that was most notable after extended periods of ambulation. The lesions initially were diagnosed as plaque psoriasis by an external dermatology clinic. At the time of presentation to our clinic, treatment with several highpotency topical steroids and biologics approved for plaque psoriasis had failed. Her medical history and concurrent medical workup were notable for type 2 diabetes mellitus, liver dysfunction, thyroid nodules overseen by an endocrinologist, vitamin B 12 and vitamin D deficiencies managed with supplementation, and diffuse androgenic alopecia with suspected telogen effluvium. Physical examination revealed no plaque fissuring, pruritus, or scaling. She had no history of radiation therapy or organ transplantation. A punch biopsy of the left palm was performed.WHAT'S YOUR DIAGNOSIS? a. discoid lupus erythematosus b. lichen planus c. lichen sclerosus d. morphea e. vitiligo From the