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50-Year-Old Woman with Lesions on Soles, Wrists, and Palms

Can you diagnose this case?

Signs and Symptoms

This 50-year-old woman presented with a several-year history of annoying, but painless lesions on the insteps of the soles, wrists, and creases of her palms. She is otherwise healthy.

What is the cause of this woman’s cuplike lesions?

Choose one to reveal diagnosis and discussion

Warts
Keratosis punctata
Acrokeratoelastoides lichenoides
Palmar plantar pustulosis
Porokeratosis

Answer: Keratosis punctata

See the full case at Consultant360

Keratosis punctata is classically seen in the skin of the African American population, especially along the natural skin folds and lines. The more common version affects only creases of the palms. These lesions may temporarily respond to topical keratolytics such as urea or salicylic acid. Warts and acrokeratoelastoides usually protrude outwardly rather than the cuplike depressions seen here. There are no pustules, nor are there lesions that have a thin keratotic rim as seen in porokeratosis.

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