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JAMA Dermatology Clinicopathological Challenge
June 2014

Lifelong Desquamation of the Hands and Feet

Author Affiliations
  • 1Wright State University, Dayton, Ohio
  • 2Phoenix Dermatology, Canton, Ohio
  • 3Dermatopathology Laboratory of Central States, Dayton, Ohio
JAMA Dermatol. 2014;150(6):647-648. doi:10.1001/jamadermatol.2013.9190

A man in his 60s presented with asymptomatic peeling of the hands and feet. The patient stated that this had occurred “for as long as he could remember.” The patient stated the peeling skin occurred predominately on his hands and feet but also occurred, less frequently, on his knees. The patient denied pruritus or burning sensation. He complained of hyperhidrosis, which seemed to exacerbate the condition, as well as mechanical trauma, including activities such as long walks when wearing shoes. The patient denied any change in the condition with seasonal variation. He denied having any other family members with similar findings. Physical examination revealed fine scaling, bilaterally, on the dorsal surface of the hands and erythematous erosions with peripheral desquamation located on the dorsal and lateral aspects of the hand and digits. (Figure, A and B) A punch biopsy was performed on a blister found on the right palmar surface, and the specimen was processed and stained with hematoxylin-eosin (Figure, C).

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