Massive papillary dermal fatty infiltration in a patient with psoriasis

A 36-year-old Caucasian man presented with chronic, slightly erythematous, scaly plaques of 6 years duration. Some improvement was noticed after treatment with topical steroids. Differential clinical diagnoses included psoriasis and eczema. A biopsy revealed psoriasiform changes with "fatty vacuoles" replacing the papillary dermis. The histogenesis of these findings is unknown. Even though small foci of fatty vacuolization have been observed in association with heavy inflammatory infiltrates in skin, this is the first reported case of massive fatty infiltrates in a non-neoplastic disorder of the skin associated with only sparse inflammatory infiltrate.