Bullous lesions in Bazex syndrome and successful treatment with oral psoralen phototherapy

A 59-year-old man presented with a psoriasiform dermatitis with associated bullae and destructive nail dystrophy of the hands and feet. He had lost 10 kg weight over 6 months and a mass in the neck was noted. He was provisionally diagnosed with Bazex syndrome (acrokeratosis paraneoplastica) and sub sequent investigations revealed a squamous cell carcinoma in the right piriform fossa. His skin lesions were treated with oral psoralen and ultraviolet. A photo therapy and this cleared the cutaneous changes, but the nail changes have persisted at 18 months follow up.