Back issues No.2 - 2003 / Resident Forum  

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Oral Ulcer and Multiple Painful Eruption in a Patient with Chronic Psoriasis
Yu-Liang Hsiao, Sung-Jan Lin, Tsen-Fang Tsai
Dermatol Sinica 21: 207-208, 2003

Case Report
A 69-year-old man had chronic plaque psoriasis for ten months. Many new psoriatic plaques and generalized exfoliation developed during a flare 2 months ago after treatment with herbs. MTX, 7.5 mg weekly in three divided doses 12 hours apart, was initiated since three weeks ago. Erythroderma resolved dramatically within one week. Oral ulcers and painful eruptions superimposing on psoriatic plaques developed over the whole body two weeks after the initiation of MTX. After admission, physical examination revealed multiple round or oval, bean to half-palm-sized, brownish, tender plaques with central shallow erosions over his extremities and trunk (Fig. 1). The laboratory data were all within normal limits. A biopsy specimen was taken from a lesion on his lower leg.
Histopathological examination revealed many dyskeratotic cells and ballooning keratinocytes with dysmaturation of the epidermis. Metaphase arrest in mitotic cells was also noted (Fig. 2) There was a dense lymphocytic infiltrate in the superficial dermis. Neither eosinophil nor evidence of vasculitis was noted. Bisbenzimidazole dye Hoechst 33258 (H33258) show nucleus of epidermal cells and TUNEL stain show apoptosis of epidermal cells (Fig. 3 A&B).

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