We report a 44-year old farmer presenting asyntomatic skin lesions of the hands and feet with 2 years of evolution. There was no history of arsenic exposure and no known family history of hyperkeratosis.

On physical examination, multiple punctate hyperkeratotic papules, size varying from 2-6 mm were present on the palms (Fig.1) and soles (Fig.2).

Blood analysis were normal and serologic testing for HIV and syphilis negative. Further investigations to exclude malignancy, incluiding gastrointestinal endoscopy and chest-abdomen-pelvis CT, didn’t reveal any significant changes. Histological examination showed hypergranulosis and marked orthokeratotic hyperkeratosis.

Even though the lack of positive family history, the diagnosis of late-onset type 1 punctate palmoplantar keratoderma (PPPK) was made on the basis of clinical and histological findings. Despite being a rare autosomal-dominant condition, usually manifested between 12-30 years of age, some later onset cases have been described.^{1 -2}

Topical keratolytic agent was proposed but the patient refused treatment.

Figura I

Numerous small punctate hyperkeratotic papules on the palmar region of both hands.

Figura II

Focal hyperkeratosis predominantly over the pressure points of the soles.

  BIBLIOGRAFIA  

1. Naveen KN, Pai VV. A classical case of punctate palmoplantarkeratoderma: A rare entity. Indian Dermatology Online Journal. 2014;5(2):235.

2. Schiller S, Seebode C, Hennies HC, Giehl K, Emmert S. Palmoplantar keratoderma (PPK): acquired and genetic causes of a not so rare disease. J Dtsch Dermatol Ges. 2014 Sep;12(9):781-8.