A 67-year-old man presented with multiple brown-reddish lesions that had first been noted on the left side of his trunk during early childhood. Similar lesions developed on all extremities during adulthood. The patient's family history revealed that his mother also had hyperkeratotic papules disseminated on her extremities but his children were apparently free of skin disease.
Physical examination revealed that the lesions on the trunk were linearly arranged and showed central atrophy, while their borders were demarcated by a slightly elevated keratotic rim (Figure 1). Similar but less pronounced papules were found on the lower (Figure 2) and upper extremities. Punch biopsy specimens were obtained from the left side of the trunk (Figure 3) and the lower part of the leg.
Goebeler M, Bröcker E, Hamm H. Keratotic Plaques on the Left Trunk Area and All Extremities—Quiz Case. Arch Dermatol. 2006;142(8):1059-1064. doi:10.1001/archderm.142.8.1059-c