To the Editor.—
Three recent articles have described a previously unrecognized type of punctate palmoplantar keratoderma. Unlike more classic types, the clinical descriptions and photographs are typified by spiny, filiform and acuminate, seedlike, raspiform keratotic lesions. Two articles1,2 stress a porokeratotic histologic picture. The third3 mentions the presence of focal parakeratosis along with focal verruciform hyperkeratosis. Most other forms of punctate keratotic protrusions have classically been described as showing simple hyperkeratosis with underlying acanthosis; if parakeratosis is seen, it is minimal and incidental. Two articles1,3 mention an autosomal dominant pattern of inheritance; the latter3 describes a previously unrecorded associated genodermatosis (facial and cervical sebaceous hyperplasia), involving only the male side of the pedigree. The other paper2 deals with an acquired and nonhereditary form.It is to be hoped that as more cases of spiny, acuminate punctate keratoderma of the palms and soles are clinically,
Herman PS. Punctate Keratoderma. Arch Dermatol. 1974;109(6):910. doi:10.1001/archderm.1974.01630060078025
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