Indian Journal of Dermatology
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E-IJD® - CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 446
Low-Dose Oral Retinoid Combined with Topical Therapy Successfully Treats Punctate Palmoplantar Keratoderma Lesions Misdiagnosed as Corns: A Case Report


Department of Dermatology, College of Medicine, Hallym University Sacred Heart Hospital, Anyang-si Gyeonggi-do, South Korea

Date of Web Publication17-Sep-2021

Correspondence Address:
Kwang Ho Kim
Department of Dermatology, College of Medicine, Hallym University Sacred Heart Hospital, Anyang-si Gyeonggi-do
South Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_459_20

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How to cite this article:
Jung JW, Hong EH, Park EJ, Kim KJ, Kim KH. Low-Dose Oral Retinoid Combined with Topical Therapy Successfully Treats Punctate Palmoplantar Keratoderma Lesions Misdiagnosed as Corns: A Case Report. Indian J Dermatol 2021;66:446

How to cite this URL:
Jung JW, Hong EH, Park EJ, Kim KJ, Kim KH. Low-Dose Oral Retinoid Combined with Topical Therapy Successfully Treats Punctate Palmoplantar Keratoderma Lesions Misdiagnosed as Corns: A Case Report. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 3];66:446. Available from: https://www.e-ijd.org/text.asp?2021/66/4/446/326124




Sir,

Palmoplantar keratoderma (PPK) is a condition that presents with hyperkeratotic papules or plaques on patients' palms and soles. PPK is rare and only a few cases are reported in the available literature. We report a rare case of punctate PPK type 1 in which the patient's lesions were initially misdiagnosed as corns and were finally accurately diagnosed based on skin biopsy and a positive family history.

A 60-year-old man was referred to the Department of Dermatology for painful skin lesions on both palms and soles. Physical examination showed multiple hyperkeratotic papules and plaques at these sites [Figure 1]a. Considering his occupation (carpenter), these lesions were previously diagnosed as corns and he received six cycles of cryotherapy; however, his skin lesions and symptoms persisted. A punch biopsy was performed on a hyperkeratotic papule on his palm for accurate diagnosis. The biopsy revealed a thick, compact epidermal hyperkeratosis and acanthosis with central invagination and focal parakeratosis. Vascular proliferation was observed in the upper dermis; however, no obvious inflammation was identified [Figure 2]. He revealed that his skin lesions had developed when he was young and his brother and son also had similar lesions. Based on the clinical and histopathological findings, the patient was diagnosed with PPK with a high index of clinical suspicion for punctate type. Moreover, the patient complained of pain and showed a genetic pattern close to the autosomal dominant, suggesting a diagnosis of punctate PPK type 1. Treatment was initiated with low-dose acitretin, topical calcipotriol, and 20% urea cream. The patient's skin lesions and symptoms improved after two months of treatment [Figure 1]b.
Figure 1: Image showing multiple hyperkeratotic punctate papules and plaques on the patient's bilateral soles (a) and changes observed in the lesions after two months of treatment with oral acitretin, topical 20% urea cream and topical calcipotriol (b)

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Figure 2: Histopathological examination of a skin biopsy specimen from the palm showing hyperkeratosis and acanthosis in the epidermis with central invagination and focal parakeratosis

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PPK is classified into various types based on the clinical and histopathological features and inheritance patterns.[1] Punctate PPK presents with several round hyperkeratotic papules (measuring approximately 1 mm–1 cm) distributed on the palms and soles.[2] The histopathological findings of punctate PPK include marked hyperkeratosis and acanthosis of the epidermis without dermal inflammation.[3] The punctate type is subclassified into types 1, 2 and 3 based on pain, inheritance patterns or the role of contributory genes.[4]

Because punctate PPK shows hyperkeratotic papules on weight-bearing areas, it may resemble corns. In this patient, the lesions were initially misdiagnosed as corns and the patient received six cycles of cryotherapy before visiting our clinic. Clinicians should consider biopsy for accurate diagnosis in patients in whom a corn is refractory to treatment and the lesion shows multiple hyperkeratotic papules.

Currently, no standard therapy is available for PPK and treatment is primarily symptomatic in nature.[3] A few reports in the available literature describe that low-dose oral acitretin and topical keratolytics effectively treat PPK.[3],[5] Although systemic retinoid administration is associated with the risk of adverse effects, it is necessary for maintenance therapy. Administration of topical retinoids and keratolytics combined with systemic retinoids can reduce the dosage and likelihood of adverse effects. Herein, we report a rare case of punctate PPK type 1 in a patient who was successfully treated with systemic low-dose acitretin combined with topical therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Itin PH. Classification of autosomal dominant palmoplantar keratoderma: Pastderma: Pasttode. Dermatology 1992;185:163-5.  Back to cited text no. 1
    
2.
Martinez-Mir A, Zlotogorski A, Londono D, Gordon D, Grunn A, Uribe E, et al. Identification of a locus for type I punctate palmoplantar keratoderma on chromosome 15q22–q24. J Med Genet 2003;40:872-8.  Back to cited text no. 2
    
3.
Gupta R, Mehta S, Pandhi D, Singal A. Hereditary punctate palmoplantar keratoderma (PPK) (Brauer-Buschke-Fischer syndrome). J Dermatol 2004;31:398-402.  Back to cited text no. 3
    
4.
Pai VV, Kikkeri NN, Athanikar SB, Sori T, Rao R. Type I punctate palmoplantar keratoderma (Buschke-Fisher-Brauer disease) in a family—A report of two cases. Foot (Edinb) 2012;22:240-2.  Back to cited text no. 4
    
5.
Jo JW, Jeong DS, Kim CY. Case of punctate palmoplantar keratoderma type I treated with combination of low-dose oral acitretin and topical salicylic acid and steroid. J Dermatol 2018;45:609-12.  Back to cited text no. 5
    


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