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July 1997

Multiple Asymptomatic Hyperkeratotic Papules on the Lower Part of the Legs

Author Affiliations

National Taiwan University Hospital, Taipei

Arch Dermatol. 1997;133(7):913-914. doi:10.1001/archderm.1997.03890430133021

REPORT OF A CASE  A 67-year-old man presented with multiple, solitary, reddish-brown, flat, hyperkeratotic, 1- to 5-mm papules, predominantly on his left shin. The lesions were asymptomatic and had persisted for more than 20 years. On removal of the spiny scale, pinpoint bleeding was observed (Figure 1 and Figure 2).An excision biopsy specimen of a lesion on the left shin is shown in Figure 3.What is your diagnosis?

DIAGNOSIS:  Hyperkeratosis lenticularis perstans (HLP) (Flegel disease).

DISCUSSION  Hyperkeratosis lenticularis perstans is a rare dermatosis first described in 1958 by Flegel.1 The disorder is characterized by 1- to 5-mm, asymptomatic, reddish-brown, keratotic papules located principally on the dorsa of the feet and the lower part of the legs. Involvement of the pinnae, arms, palms, soles, and even oral mucosa2has been noted. Removal of the adherent horny scale above each papule causes pinpoint bleeding.

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