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November 17, 2008

Long-standing Spiny Papules on the Lower Extremities—Diagnosis

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

Findings from the biopsy specimen demonstrated a circumscribed focus of lichenoid inflammation associated with atrophy of the stratum spinosum, hypogranulosis, and an overlying sharply circumscribed column of pale-staining orthokeratotic hyperkeratosis. The patient was treated with urea cream, 10%. She was subsequently lost to follow-up.

Flegel disease, or HLP, was first described by Flegel1 in 1958. It is a rare condition arising in the third or fourth decade of life, characterized by asymptomatic keratotic papules on the distal extremities, primarily the feet and legs. Typical lesions are skin-colored to reddish-brown papules surmounted by a horny adherent scale that when removed reveals a saucer-shaped base and pinpoint bleeding. Involvement of the palms, soles, and oral mucosa has been described.

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