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Discrete Keratoderma (Michael). Presented by Dr. George H. Curtis and Dr. E. W. Netherton.
H. N. W., a white man aged 38, has had lesions on the dorsa of the hands for eight years. There have been periods of improvement and exacerbation. During the exacerbations the lesions are thickened and tend to become fissured. They have never been pruritic and are not affected by the seasons, nor do they improve when he is away from work for from a few weeks to a year at a time.There are a number of dry brownish red and fairly well demarcated plaques on the dorsa of the hands and knuckles. They vary from 1 to 3 cm. in diameter, the smaller lesions being roughly circular and the larger ones irregular in shape. The surfaces vary from slightly scaly to mildly verrucous. The lesions on the knuckles show a tendency toward fissuring. The