Fig. 1.

Clinical and histological presentation of paradoxical psoriasis. a–c Photographs of cutaneous lesions and corresponding histopathology of three individual patients presenting paradoxical psoriasis. a Patient 1 with small erythemato-squamous plaques disseminated over the entire body resembling guttate psoriasis and palmoplantar psoriasis-like lesions. Histology with a classical psoriasis pattern with acanthosis, papillomatosis, parakeratosis, and loss of the granular layer, but with spongiosis. b Patient 2 with partially crusted, eczematiform lesions on her legs and trunk, palmoplantar psoriasis-like lesions, and severe scalp involvement. Histology with acanthosis, papillomatosis, also in addition to spongiosis and minimal interface dermatitis. c Patient 3 with small erythematous plaques and pustules. Noncicatricial alopecia on the site of scalp involvement. Histology with acanthosis, papillomatosis, and spongiosis. Clinical signs and histopathology of the patients shown are representative of the patient population in this study