Acral hemorrhagic variant of dyskeratosis follicularis (Darier disease)

A 76-year-old woman presented with a venous leg ulcer 7. Incidentally hemor rhagic macules on hands and fingers and dystrophy of toe and fingernails we re noticed. Except for submammary erythema, no further dermatologic signs w ere shown. Histology of palmar lesions fit with a hemorrhagic lesion of dys keratosis follicularis in acral skin. During following months actinic induc ed reddish-brown hyperkeratotic papules appeared on the forehead and in seb orrheic and intertriginous areas of the trunk. Papules were most prominent during summer and almost completely resolved in winter. The hemorrhagic var iant of dyskeratosis follicularis represents a rare clinical variant which has to be separated from other purpuric macules on acral sites.