A 69-year-old white man presented with a 1-month history of mildly pruritic lesions on his hands and feet. He had a medical history of hyperlipidemia, diverticulitis, and mild hypertension, for which he used aspirin, pravastatin sodium, calcium polycarbophil (FiberCon; Wyeth Consumer Healthcare, Madison, NJ), and ramipril. The ramipril therapy was initiated after the appearance of the skin lesions. There were no recent changes in medication or dosages. The patient denied a history of atopy, recent infection, chemical or arsenic exposure, and autoimmune disease. A review of systems was negative for fevers, chills, myalgias, arthralgias, headache, or weight change.
Rotunda AM, Craft N, Haley JC. Hyperkeratotic Plaques on the Palms and Soles—Quiz Case. Arch Dermatol. 2004;140(10):1275-1280. doi:10.1001/archderm.140.10.1275-c