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                                            1. December 2003

                                            (Prize: A medical Book)

           (Quiz can be answered from 1st December till 31st December)

                        A 40-year-old woman presents with a highly debilitating hand rash that started six weeks prior to this visit. She was referred by her primary care provider after he treated her with oral antibiotics (cephalexin 500 mg four times a day for 10 days) to no good effect. The patient is otherwise in good health, with no history of skin diseases or other serious illness. She has, however, been under more stress than she is accustomed to.

                       The examination shows a bilateral palmar eruption characterized by discrete and coalescent pustules and erosions, producing raw skin in the central palm of both hands. There are no palpable nodes in either epitrochlear or axillary locations, and there is little if any redness around the rash. Examination elsewhere reveals a few 1- to 2-cm papulosquamous lesions on the legs; the patient reports that these appeared at about the same time as the palmar eruption. Moreover, there are pits in three of 10 fingernail plates, and a curious pink rash without scale in the upper intergluteal area. The feet are clear.

Questions:

What is the diagnosis?

What investigation would confirm your diagnosis?

Correct Answers:

-    Psoriasis

-    Skin Biopsy.

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