Slowly Progressing, Hyperkeratotic Papules on Hands and Feet

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Palmoplantar Papules
Source: The New England Journal of Medicine

Palmoplantar papules – a chronic skin condition

This article describes the case of a 68-year-old female patient who presented to the dermatology clinic with slowly progressing, yellowish, hyperkeratotic papules and plaques on the hands and feet. However, the patient did not complain of any pain, itching, nail changes or skin fragility. Based on clinical and biopsy findings, doctors diagnosed the patient with palmoplantar papules.

The patient’s mother, son and granddaughter had similar skin lesions. Histopathological analysis of the lesion showed hypergranulosis and orthohyperkeratosis. The findings led to the diagnosis of palmoplantar keratoderma. DNA sequencing via next generation sequencing showed a nonsense mutation in AAGAB in both the patient and her son. The AAGAB is responsible for coding the alpha and gamma adaptin binding protein.

The AAGAB mutation is consistent with the diagnosis of autosomal dominant hereditary punctate palmoplantar keratoderma type 1.

Doctors further advised chest radiography, upper endoscopy, colonoscopy, Papanicolaou testing and mammography, all of which did not show any significant findings. Treatment included topical ointments, 40% urea and 20% salicylic acid. This helped with mild reduction of the hyperkeratosis. With treatment, doctors also advised regular cancer screenings.

Palmoplanter keratoderma is a very rare hereditary skin condition that causes irregularly distributed epidermal hyperkeratosis. It is also known as Buschke-Fischer Brauer syndrome and generally affects the palms and soles. However, may vary for each patient.

References

Palmoplantar Papules https://www.nejm.org/doi/full/10.1056/NEJMicm2032907

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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