Armour-like hyperkeratosis

This is erythrodermic psoriasis on the chest of a man in his 30s (fig 1).bmj;379/oct12_5/e070300/F1F1f1Fig 1The patient had a 14 year history of chronic plaque psoriasis and arthritis in both hands. For four years he had used methotrexate and acitretin but abruptly stopped treatment on deterioration of his mental health. Over the six months after withdrawal, erythema gradually became widespread and confluent.Physical examination showed erythroderma with patchy thick silvery scale involving more than 90% of body surface area. The patient had no fever, chills, or pustules.Erythrodermic psoriasis is a severe subtype of psoriasis, characterised by widespread, confluent erythema with scaling and desquamation of the skin and is usually associated with fever, chills, and malaise. Erythrodermic psoriasis can be triggered by sudden withdrawal of systemic drugs, infection, alcohol consumption, and stress.12 Differential diagnoses include crusted scabies, pityriasis rubra pilaris, and cutaneous T cell lymphoma.Patients should be counselled on how the sudden…
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