REPORT OF A CASE
A 63-year-old woman with a history of localized psoriasis on her scalp presented for evaluation of generalized pruritic psoriasiform lesions. Otherwise she felt well.
On examination, generalized erythematous, scaly, well-circumscribed and confluent plaques were seen on the legs, thighs (Fig 1), arms, back, chest, and abdomen (Fig 2). Her face, hands, and feet were spared. Vesicles, pustules, and burrows were absent. A clinical diagnosis of generalized psoriasis was made, and the patient was treated with 0.1% triamcinolone ointment twice daily and a modified Goekerman treatment on an inpatient basis.
The patient's symptoms improved initially with topical triamcinolone treatment and then became worse. She could no longer sleep because of her severe pruritus. A random skin biopsy specimen was obtained from a psoriasiform lesion on the right thigh. Microscopic examination revealed a surprising finding (Figs 3 and 4).
What is your diagnosis?
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