This 62-year-old African-American man with sarcoidosis and prostate cancer acquired an ichthyosiform condition, clinically resembling ichthyosis vulgaris. Acquired ichthyosis has been associated with sarcoidosis, as well as HIV, connective tissue disease, drugs, and malignancies. The histology of ichthyosis is subtle, and falls into the "normal skin" differential, requiring clinical history. The histology resembles ichthyosis vulgaris, showing thickened compact orthokeratosis and an attenuated granular layer, as in this case.
Histologic sections of skin show mild regular epidermal acanthosis with overlying hypogranulosis and compact hyperorthokeratosis. There is apparent plugging of a follicular orifice. Inflammation is absent.