Zosteriform Darier's disease versus acantholytic dyskeratotic epidermal nevus

Patients with keratotic lesions distributed in a unilateral, linear, zoster iform or localized pattern and revealing histologic features of dyskeratoti c acantholysis have been reported. There is still some controversy regardin g the appropriate nosologic placement of this entity. Some believe it repre sents a localized form of Darier's disease, while others argue it is a vari ant of epidermal nevus. We report a case of a 42-year-old physician who pre sented with a 15-year history of an asymptomatic eruption that had been dia gnosed as "chronic zoster." Physical exam revealed hyperkeratotic papules a nd plaques in a dermatomal distribution. The controversy regarding the corr ect nosologic placement of such a patient is discussed.