Chronic papules on the back and extremities

Differential diagnosis

For hyperkeratotic plaques on the back and extremities, several diagnoses should be considered.

Psoriasis is a papulosquamous hyperproliferative disorder, with underlying autoimmune mechanisms.

Seborrheic dermatitis is another papulosquamous disorder involving the sebum-rich areas of the scalp, face, and trunk. In addition to sebum, is is linked to Pityrosporum ovale, immunologic abnormalities, and activation of complement.

Transient acantholytic dermatosis, or Grover’s disease, is a benign, self-limited disorder; however, it may be persistent and difficult to manage. The process usually begins as an eruption on the anterior part of the chest, the upper part of the back, and the lower part of the chest.

Familial benign pemphigus is a chronic autosomal dominant disorder with incomplete penetrance, which manifests clinically as vesicles and erythematous plaques with overlying crusts, which typically occur in the genital area, as well as the chest, neck, and axillary areas.

Management: retinoids, laser surgery

Therapeutic options are palliative. A multidisciplinary approach is often necessary; family physicians as well as dermatologists, and occasionally plastic surgeons, have important roles in managing this chronic condition.

Treatment options for Darier’s disease range from topical to systemic medications and laser therapies. Successful topical therapies include corticosteroids, retinoids, urea, salicylic acid, 5-fluorouracil, and topical antibiotics.^5,6