A patient in their 50s presented with asymptomatic keratotic papules, first noticed on the left middle and ring fingers and left toe web spaces more than 10 years earlier. The papules progressed proximally over the subsequent decade to involve the forearm, arm, scapular area, ankle, shin, and thigh, but only affected the left side of the body. The patient’s face, palms, soles, and entire right side of the body were spared. The patient has a history of rosacea being treated with topical metronidazole gel for flares but was otherwise asymptomatic. The patient did not have any alopecia, night blindness, or dry eyes or skin. There was no history of any exposure to radiation or arsenic, nutritional deficiency, inflammatory skin disease, or malignant neoplasm. There was no family history of a similar condition.
Tay WC, Tee S, Cheng SWN. A Case of Unilateral Focal Hyperkeratosis. JAMA Dermatol. 2022;158(4):447–448. doi:10.1001/jamadermatol.2021.5931
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