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JAMA Dermatology Clinicopathological Challenge
November 2018

An Atrophic and Spiny Eruption of the Palms

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2018;154(11):1344-1345. doi:10.1001/jamadermatol.2018.1265

A woman in her 60s presented for initial dermatologic evaluation of a 2-year history of a pruritic and sometimes burning hyperpigmented eruption on the bilateral palms. The eruption had gradually spread from the left palm to the right palm and then focally onto the bilateral volar aspect of the wrists in recent months (Figure, A and B). She had not experienced involvement of the plantar surfaces. No additional concerns were reported, and there was no family history of similar lesions. There was no known history of travel in relation to onset of the lesions. Limited clinical examination revealed well-marginated brown atrophic patches on the bilateral palms extending focally onto the volar aspect of the wrist and centrally surmounted by spiny keratotic pits in the palmar creases. Two punch biopsy specimens were obtained for diagnostic clarification (Figure, C and D).

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