A 12 years old boy with erythematous hyperkeratotic plaques on the palms and soles

A 12 years old boy, diagnosed with psoriasis since childhood was referred to the dermatology clinic of Aleppo University Hospital,Syria with the chief complaint of erythematous hyperkeratotic lesions on the palms and soles (Figure 1). Similar symmetrical hyperkeratotic areas were extended on the dorsal surfaces of the extremities as well as on knees and elbows, which appeared to worsen during winter and were associated with painful fissures. Well demarcated psoriasiform plaques were noted bilaterally on the elbows and knees (Figure 2). The patient had also pilar keratosis on the back and nail changes in the form of transverse grooving. Furthermore, he complained of deformity of the teeth. According to his mother, the patient had a delayed teeth development. Physical examination revealed malformed teeth, periodontitis and swelling of gingiva (Figure 3) and most of the remaining permanent teeth were mobile. Parental consanguinity was negative but there was positive history of same problem in his cousin. General physical examination was normal with no evidence of systemic disease.There was no history of infection or other diseases.