Multiple pruritic eruptions and hyperpigmentation

A woman in her 40s presented with a three year history of pruritic eruptions on the dorsum of her hands. She had previously been treated for fungal infection, eczema, and lichen planus using antifungal ointment, and topical and oral corticosteroids, but showed no improvement. She also reported a history of anhidrosis. She was known to have polycythaemia vera and had been taking hydroxyurea for many years. On examination, symmetrical keratotic, flat, and polygonal violaceous plaques with telangiectasia were observed on the dorsum and palms of her hands. Dark brown longitudinal pigmentation was seen in the nails. Facial examination showed hyperpigmentation and telangiectasia. Additionally, the patient presented with ichthyosis-like lesions (light brown, dry, polygonal scaly lesions) on both legs, accompanied by apparent hyperpigmentation (fig 1). Laboratory evaluation showed unremarkable results for electrolytes, creatine kinase, antinuclear antibodies, erythrocyte sedimentation rate, C reactive protein. Test results for hepatitis, HIV, and syphilis were also negative. Histopathological analysis of a hand …