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Punctate palmoplantar keratoderma

Punctate palmoplantar keratoderma is often familial, where it tends to be inherited as an autosomal dominant trait. Such lesions tend to be present by early adulthood.
Punctate palmoplantar keratoderma can also be secondary to previous arsenic exposure, and in this case usually appear in middle age or later. When secondary to arsenic exposure, there is an association with the development of squamous carcinoma of the skin and lung.
There may also be an association of non-arsenical acquired punctate keratoderma with internal cancer but that association, if present, is not well defined.
Clinically, plugs of compressed keratin are present on the palmar and plantar surfaces. If larger, lesions are painful on compression such as that caused by walking.

Treatment:

  • Lesions become asymptomatic if pared. Such debridement is the only treatment required for most.
  • Keratolytic ointments such as 10-25% salicylic acid in petrolatum can be helpful in extensive cases.
  • Oral retinoids are indicated only in very severe cases as treatment would need to be continued for life.


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