IV Balearic Meeting of European Residents and GP of IBAMFIC

Palmoplantar keratoderma in smoker patientCerdó Ensenyat, M.; López Díaz, A.C.

Palmoplantar hyperkeratosis and fissures

Woman, 59 years old. Working as Chef. Smoker. COPD. Refer since 8 months ago palmoplantar hyperkeratosis associated with onychodystrophy that has progressed despite treatment with high potency topical corticosteroids, keratolytic and mitotic inhibitor treatment (oral and topical). It associate weight loss of about 7 kg in the last 15 days. She hasn’t cought, depositional alteration or other symptoms.

Study was completed by body CT and PET-CT that confirmed the presence of lung mass with adenopathic parahiliar conglomerate without metastases. Bronchoscopy confirmed the presence of a small cell carcinoma.

Given these findings, cutaneous syndrome Bazex was oriented. This is a rare paraneoplastic phenomenon associated with squamous cell carcinoma of the upper aerodigestive tract, described as associated with other tumors though. It comes in the form of erythematous psoriasiform plaques mainly located in acral locations. It can be associated with onychodystrophy, palmoplantar keratoderma and alopecia.

In most patients, skin manifestations precede the diagnosis of neoplasia, but up to a third of cases it is diagnosed at the same time or before the Sde Bazex.

Palmoplantar keratoderma is a frequent reason for consultation in primary care and most often has a genetic component and may be associated with external factors. In most cases it has a benign course and responds favorably to treatment with emollients and topical steroids. Should bad evolution occur, the differencial diagnosis must be extended and think of entities as Bazex Syndrome.

Hyperkeratosis and fissures in palms and soles of the feet with nail pitting and subungual hyperkeratosis. Some hyperkeratotic and erythematous plaques on extensor areas and one in occipital region. Cardiopulmonary auscultation: normal. Abdomen: normal No palpable lymphadenopathy.

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Bibliography· Humphrey SR, Hussain AS, Chandran R, Wilson B, George B. Acute Onset of Acrokeratosis Paraneoplastica (Bazex Syndrome). JAMA Dermatol. 2015 Jun;151(6):677-8·Uptodate. Teresa S Wright, MD, FAAD, FAAP. The genodermatoses. Feb 22, 2016. http://www.uptodate.com/· Uptodate. Josep Dalmau, MD, PhD, Myrna R Rosenfeld, MD, PhD. Overview of paraneoplastic suyndromes of the nervous system. Aug 10, 2016. http://www.uptodate.com/· Robert M, Gilabert M, Rahal S, Ries P, Raoul JL. Bazex syndrome revealing a gastric cancer. Case Rep Oncol. 2014 Apr 30;7(1):285-7.

Analytical anodyne. Chest XR: parahiliar right mass (pulmonary VS mediastinal)

Hyperkeratosis: Palmoplantar psoriasis, contact eczema, pityriasis rubra, paraneoplastic syndrome.

Parahiliar mass : Lymphadenopathy, Lymphoma, teratoma, Sarcoidosis, inflammatory pseudotumor, granuloma, pulmonary neoplasia or another cause with pulmonary metastases.

Oral retinoids // Treatment for the base disease.