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A30-year-old woman with a history of psoriasis on her scalp was referred to our dermatology clinic for psoriasis on her hands that had lasted for 1 year and was resistant to topical treatments. The patient had no history of muscle weakness.
On examination, multiple hyperkeratotic, flat, red papules with central atrophy were present on the backs of the patient's metacarpophalangeal and interphalangeal joints (Figure 1). Cuticular hypertrophy and periungual capillary dilatation were also seen (Figure 1, inset). In addition, she had a very subtle heliotrope rash around her eyes. A biopsy of skin from the patient's...