Hyperkeratotic psoriasis is a rare variant that includes forms such as elephantiasis, considered the rarest. It is characterized by thick, persistent plaques, resembling elephant skin, located mainly on the extremities and buttocks. Early detection and appropriate treatment, including systemic therapies, are essential for its management.
Clinical case
A 58-year-old male patient presented in 2018 with dermatosis on his forehead, right elbow, and the backs of both hands. He was initially diagnosed with seborrheic dermatitis and chronic lichen simplex and received multiple topical therapies without improvement. In 2024, he developed new, disseminated lesions on his elbows, hands, and both legs, characterized by hyperkeratotic plaques and excoriations. A biopsy confirmed the diagnosis of elephantiasis variant hyperkeratotic psoriasis. Treatment with ustekinumab was initiated, resulting in significant improvement of the lesions.
Conclusions
Elephantine psoriasis is a rare and difficult-to-treat variant, with few reported cases, which hinders the standardization of its management. Biologic therapies represent an effective alternative for improving prognosis, reducing complications, and preventing progression to other associated pathologies. Disseminating these cases is essential to expanding knowledge of this variant and optimizing available therapeutic options, for the benefit of patients.
