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A 63-year-old woman presented with a 6-year history of a cutaneous eruption in a distinctive linear and reticular pattern. Hyperkeratotic dark erythematous papules with fine white scaling were spread mainly on the interior sides of her arms (Fig. 1A) and legs (Fig. 1B). Erythema and scaling was present on the perioral region (Fig. 1C). In addition, she had painful oral ulcers on the mucosal lips, buccal mucosa and tongue (Fig. 1D). Periungual erythema and swelling was present on the fingers (Fig. 1E). She had tender, erythematous subcutaneous nodules on the lower legs (Fig. 1F). Skin biopsy from the linear hyperkeratotic plaques demonstrated a partially acanthotic and atrophic epidermis with parakeratosis, dyskeratosis and an underlying lichenoid interface dermatitis. The dermal infiltrate mainly contained lymphocytes and histiocytes (Fig. 2) The patient had a history of signs reminiscent of sarcoidosis in the lung. Bilateral hilar shadowing was detected on X-ray 5 years previously. Treatment with methotrexate for 2 years led to complete regression of pulmonary infiltration. The cutaneous symptoms were not significantly ameliorated.

Linear Hyperkeratotic Papules on Extremities Together with Oral Ulcers: A Quiz