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November 17, 2008

Long-standing Spiny Papules on the Lower Extremities—Quiz Case

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Arch Dermatol. 2008;144(11):1509-1514. doi:10.1001/archderm.144.11.1509-c

A 48-year-old woman presented with a rough, scaly eruption of 10 years' duration involving the dorsal feet and legs. It was asymptomatic and persistent despite treatment with emollients and mechanical exfoliation. Her medical history included asthma and allergic rhinitis. There was no history of an endocrine disorder or malignant neoplasm. The patient's mother had an identical long-standing asymptomatic eruption. Physical examination revealed dozens of discrete, irregularly shaped, keratotic, spiny, skin-colored papules involving the dorsal feet and ankles (Figure 1). Similar papules were scattered to a lesser extent over the patient's bilateral legs and thighs. The dorsal hands were spared. There were no palmar or plantar pits. Manual removal of the adherent lesional scale revealed a shallow crater with an erythematous, shiny base. Findings from the remainder of the cutaneous examination were unremarkable. A 3-mm punch biopsy specimen was taken from a representative lesion on the foot for histologic examination with hematoxylin-eosin (Figure 2 and Figure 3).

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