History: A 39-year old African American male presented with a 1-year history of small scaly papules on his hands and feet which progressed to involve large portions of his body surface area. He was initially diagnosed with psoriasis and treated with numerous topical therapies as well as soriatane and methotrexate. All of these therapies were ineffective. Approximately one year after his rash began, the patient also developed diabetes and underwent further work-up including a CT of the abdomen. A skin biopsy was also performed.
Physical Exam: There were erythematous and slightly
scaly papules some with superficial erosions present on the abdomen
(Fig. 1). On theknees, shins and feet were psoriasiform plaques
with eroded margins (Figs.2,3). Scaly, eroded plaques were present
on the soles of the feet
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