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Case Number : Case 2567 - 08 May 2020 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F45. Palm biopsy. 3y multiple keratotic papules both palms & soles of both fee. ?punctate keratoderma ?viral warts.


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Cem Leblebici

Posted

Punctate keratoderma?

 

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AmerSM

Posted

Porokeratotic eccrine ostial and dermal duct nevus

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Krishnakumar subramanian

Posted

focal Invaginated orthohyperkeratotic column resembling coronoid lamellae, but with no parakeratosis. there is no dermal inflammation

Think of type 1 punctate palmo-plantar keratoderma

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Dr. Richard Carr

Posted

Well thanks all for attempting a "keratoderma" differential. I was fairly confident of the diagnosis of palmoplantar keratoderma (as suggested by clinical colleague) and issued my report as such. I was lucky to be able to refer to a wonderful PDF of a lecture given to the National Skin EQA by Professor Dieter Metze.

Given that I was sharing the case and I would not consider myself expert on keratodermas I asked Dieter Metze for his opinion on the images.

He kindly writes as follows:

Dear  Richard, 
clinically and histologically a very typical case of Palmoplantar keratoderma punctata, type I (PPK papulosa, PPK dissipatum, 
PPK Buschke-Fischer-Brauer). No signs of verruca (although the silhouette with inward bending of the rete ridges is a look alike!)
Very often manifestation is late.
Best regards
Dieter

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Victor Delgado

Posted

Agree with @AmerSM, there is some epidermal invagination with an overlying parakeratotic and broad cornoid lamella, just above an acrosiringyum with tortous contours. Porokeratotic eccrine ostial and dermal duct nevus.

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