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There appeared lately at the clinic for cutaneous diseases at the Massachusetts General Hospital a patient whose skin presented the following extraordinary manifestations: The whole surface, with the exception of the palms and soles, the genitals, and some portions of the flexor aspects of the arms, was thickly occupied by a variety of lesions, which may be thus analyzed:
Minute papules, the size of a small pin's head, smooth, firm, and not differing in color from the surrounding skin.
Papules somewhat larger than the above and slightly hyperæmic in appearance.
Lesions 1 and 2 closely resemble those of keratosis pilaris, but are, perhaps, not so sharply conical as the latter often are.
Still larger papules, of flattened hemispherical shape, with smooth or polished, dense coverings of nail-like consistence, and varying in color from dull-red to purplish, dusky-red, brown, and brownish-black. At a little distance they strongly resemble