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JAMA Dermatology Clinicopathological Challenge
October 2, 2019

Punctate Keratotic Papules on the Palm

Author Affiliations
  • 1Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida
JAMA Dermatol. Published online October 2, 2019. doi:10.1001/jamadermatol.2019.2956

A girl in her teens presented for evaluation of asymptomatic, punctate, keratotic papules localized to the right palm and right third proximal finger that had been present since age 2 years. Prior treatments included cryotherapy, pulsed dye laser, and 40% salicylic acid, with partial improvement reported but never complete clearance. Medical history and family history were unremarkable. Physical examination revealed grouped and circumscribed, firm, skin-colored, 1- to 3-mm papules with a central punctate dark core (Figure, A and B). A 4-mm punch biopsy from a papule on the palm was performed (Figure, C and D).

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